title: Selective non-operative management of civilian gunshot wounds to the abdomen: a systematic review of the evidence.
abstract: BACKGROUND
  Selective non-operative management (SNOM) of penetrating abdominal wounds has become increasingly common in the past two or three decades and is now accepted as routine management for stab wounds. Gunshot wounds are more frequently managed with mandatory laparotomy but recently SNOM has been successfully applied. This review systematically appraises the evidence behind SNOM for civilian abdominal gunshot wounds.
  
  
  METHODS
  A Medline search from 1990 to present identified civilian studies examining success rates for SNOM of abdominal gunshot wounds. Case reports, editorials and abstracts were excluded. All other studies meeting the inclusion criteria of reporting the success rate of non-operative management of abdominal gunshot wounds were analysed.
  
  
  RESULTS
  Sixteen prospective and six retrospective studies met the inclusion criteria, including 18,602 patients with abdominal gunshot wounds. 32.2% (n=6072) of patients were initially managed non-operatively and 15.5% (n=943) required a delayed laparotomy. The presence of haemodynamic instability, peritonitis, GI bleeding or any co-existing pathology that prevented frequent serial examination of the abdomen from being performed were indications for immediate laparotomy in all studies. Delayed laparotomy results in similar outcomes to those in patients subjected to immediate laparotomy. Implementation of SNOM reduces the rates of negative and non-therapeutic laparotomies and reduces overall length of stay.
  
  
  CONCLUSIONS
  SNOM can be safely applied to some civilian patients with abdominal gunshot wounds and reduces the rates of negative or non-therapeutic laparotomy. Patients who require delayed laparotomy have similar rates of morbidity and mortality and similar length of stay to those patients who undergo immediate laparotomy.
authors.affiliation: Department of Vascular Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham Research Park, Vincent Drive, Birmingham, United Kingdom.
authors.forename: C M
authors.initials: CM
authors.lastname: Lamb
authors.affiliation: Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham Research Park, Vincent Drive, Birmingham, United Kingdom; Department of Colorectal and General Surgery, Rotherham General Hospital, Rotherham, United Kingdom. Electronic address: Jeff.Garner@rothgen.nhs.uk.
authors.forename: J P
authors.initials: JP
authors.lastname: Garner
mesh_terms: D000007:Abdominal Injuries / Q000150:complications / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy; D006801:Humans; D007813:Laparotomy; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D010533:Peritoneal Lavage / Q000379:methods; D010538:Peritonitis / Q000209:etiology / Q000628:therapy*; D017410:Practice Guidelines as Topic; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014948:Wounds, Gunshot / Q000150:complications / Q000628:therapy*
keywords: Abdominal trauma; Gunshot wounds; Non-operative management