Outcomes of Laparotomy for Penetrating Abdominal Trauma in Military and Conflict Settings: A Scoping Review

Abstract

Penetrating abdominal trauma in military and conflict settings remains a major cause of preventable morbidity and mortality. In these environments, laparotomy remains the definitive surgical procedure for hemorrhage control, contamination management, and organ repair. Although literature on this topic is growing, outcomes following laparotomy in different conflict settings remain scattered and inconsistently reported. This scoping review aimed to map the available evidence on laparotomy outcomes in penetrating abdominal trauma across military, conflict, and conflict-adjacent environments. The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). A structured search was performed in MEDLINE/PubMed, Embase, and Google Scholar. Studies reporting outcomes after laparotomy for penetrating abdominal trauma in military, deployed, or conflict environments were included. Data were extracted on mortality, surgical site infection, non-therapeutic laparotomy rates, anastomotic outcomes, and length of hospital stay. A total of 10 studies involving 2,776 patients from military deployed settings, mixed military–civilian environments, and civilian hospitals operating in active conflict zones were included. In-hospital mortality ranged from 2.1% in evacuated military populations to 15.2% in integrated military–civilian systems. Surgical site infection rates were reported in up to 14.4% of cases. Non-therapeutic laparotomy rates ranged from 16.8% to 19.9% in military settings, while anastomotic failure occurred in up to 9.8% of intestinal anastomosis cases. Hollow viscus injury, massive transfusion requirements, and delayed evacuation were consistent predictors of poor outcomes. Overall, laparotomy outcomes vary across conflict settings due to differences in surgical capacity, patient population, and resource availability. However, common predictors of morbidity and mortality were identified. Significant gaps remain in standardized outcome reporting, particularly in humanitarian and non-governmental surgical settings, highlighting the need for coordinated data collection systems to strengthen the evidence base in conflict surgery.