Laparoscopic Versus Open Trauma Surgery: What The Review Reports

Key Takeaways

• This systematic review and meta-analysis compared laparoscopic versus open surgery in hemodynamically stable patients with penetrating and blunt abdominal trauma.
• Across 15 studies including 22,242 patients, laparoscopy was associated with a shorter hospital stay and fewer postoperative complications, without a demonstrated increase in mortality.
• The authors concluded that, in appropriately selected stable patients, laparoscopy is a safe and effective alternative to open laparotomy and supports a laparoscopic-first approach in modern trauma care.

The review included both penetrating and blunt injury mechanisms within a single comparative framework, but it focused specifically on hemodynamically stable patients, rather than all-comers with abdominal trauma. The study was designed to evaluate whether laparoscopic management offered comparable safety and better recovery outcomes than open laparotomy in this selected trauma population.

The authors performed a systematic search of MEDLINE, Embase, CENTRAL, CINAHL, and Scopus from January 1990 through February 2026 in accordance with PRISMA 2020 guidance. Eligible studies included randomized trials and observational comparative cohorts evaluating laparoscopic versus open surgery in adult or pediatric patients with abdominal trauma. Fifteen studies met inclusion criteria, comprising 22,242 patients in total: 3,965 treated laparoscopically and 18,277 treated with open surgery.

The prespecified primary outcomes were mortality and length of hospital stay (LOS). Secondary outcomes included overall postoperative complications and conversion from laparoscopy to open surgery. Random-effects models with Hartung-Knapp-Sidik-Jonkman adjustments were used for pooling, and the investigators also performed subgroup analyses, meta-regression, leave-one-out sensitivity analyses, cumulative meta-analysis, and GRADE assessments.

Among the main findings, laparoscopy was associated with a significant reduction in hospital length of stay compared with open surgery. The pooled mean difference was −3.55 days (95% CI, −4.92 to −2.18; p < 0.001), and the certainty of evidence for this outcome was graded as moderate. Subgroup analyses showed that the reduction in LOS remained significant across both penetrating and blunt trauma, supporting consistency of this benefit across injury mechanisms.

The laparoscopic approach was also associated with a 55% reduction in overall postoperative complications, with a pooled odds ratio of 0.45 (95% CI, 0.34 to 0.60; p < 0.001). The certainty of evidence for complications was graded as low, and the authors noted that these findings were susceptible to selection bias, given that most included studies were observational and surgeons may have preferentially selected less severely injured patients for laparoscopy.

For mortality, pooled analysis suggested 52% lower odds of in-hospital death with laparoscopy, with an odds ratio of 0.48 (95% CI, 0.18 to 1.30; p = 0.12). However, this result was not statistically significant, and the certainty of evidence was graded as low. The authors specifically cautioned against interpreting this as proof that laparoscopy improves survival, emphasizing that the finding may reflect confounding by indication and patient selection rather than a true mortality advantage.

The pooled conversion rate from laparoscopy to open surgery was 18.6%. The authors framed conversion not as failure, but as an appropriate intraoperative decision when visualization is limited or injuries exceed laparoscopic capability. Sensitivity analyses and cumulative meta-analysis suggested that the LOS benefit remained stable over time and was not driven by any single study. Meta-regression showed no significant time trend in the treatment effect, suggesting that the reduction in LOS has remained fairly consistent as laparoscopic trauma experience has evolved.

The review also addressed evidence quality and limitations. Most included studies were retrospective cohorts, with only one randomized trial, and heterogeneity was high for continuous outcomes such as LOS. Definitions of hemodynamic stability varied across studies, and granular pooled analysis of missed injury rates was not possible because of inconsistent reporting. Even so, the authors noted that modern studies reported negligible missed-injury rates, suggesting that improved visualization and more standardized laparoscopic exploration may have reduced this historical concern.

Overall, the authors concluded that in appropriately selected, hemodynamically stable patients with abdominal trauma, laparoscopy is a safe and highly effective alternative to open laparotomy. It was associated with shorter hospital stay, reduced postoperative morbidity, and no increase in mortality, with benefits observed in both penetrating and blunt trauma. On that basis, they argued that the findings support broader integration of a laparoscopic-first approach into contemporary trauma algorithms.