Laparoscopy in abdominal trauma at a high-volume Level 1 trauma centre in a low- and middle-income setting: A 54-month retrospective analysis

Background: Laparoscopy is a valuable surgical modality in trauma, yet its application remains underexplored. This study evaluates the feasibility and short-term outcomes of laparoscopy for abdominal trauma at a high-volume Level 1 trauma centre in Johannesburg. Methods: A retrospective cohort study of adult patients who underwent laparoscopy for abdominal trauma at Charlotte Maxeke Johannesburg Academic Hospital from January 2021 to June 2025 was conducted. Demographics, mechanism of injury, injury severity score, intraoperative findings, conversion rates, complications and length of stay were analysed. Results: Of 69 patients who underwent laparoscopy, 60 met the inclusion criteria. Median age was 30.5 years (IQR 27–38), with 95% male patients (95% CI: 86.3%–98.3%). Penetrating trauma accounted for 98.3% of cases. Negative laparoscopy occurred in 28.3% (95% CI: 18.5%–40.8%), potentially avoiding non-therapeutic laparotomy. Diaphragmatic injuries were the most common positive finding (15%). Conversion occurred in 23.3% (95% CI: 14.4%–35.4%), most commonly for definitive repair (15%). Complications occurred in 6.7% (95% CI: 2.6%–15.9%), with no in-hospital mortalities. Median length of stay was 4 days (IQR 3–7). Conclusion: Laparoscopy is feasible in carefully selected haemodynamically stable trauma patients, even in resource-constrained, high-volume settings. These findings support further investigation of laparoscopy in low- and middle-income countries, with investment in training infrastructure a key priority. Contribution: This study provides contemporary South African evidence on the feasibility and short-term outcomes of laparoscopy in selected trauma patients and supports further evaluation of its potential to avoid non-therapeutic laparotomy.