Abstract / Summary
To compare laparoscopy and laparotomy in the management of penetrating abdominal stab wounds, evaluating postoperative morbidity, mortality, non-therapeutic laparotomies, length of hospital stay, and the safety of the laparoscopic approach in hemodynamically stable patients. A systematic review with meta-analysis was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO n. CRD420261362939. The literature search was performed in March 2026 across PubMed/MEDLINE, Embase, Scopus, Web of Science, and BVS/LILACS databases. Studies published between 2010 and 2025 involving patients aged ≥ 16 years who underwent laparoscopy and/or laparotomy were included. Methodological quality was assessed using the Newcastle–Ottawa Scale and AMSTAR 2. Meta-analysis was performed using a random-effects model. A total of 330 studies were identified, of which 13 were included in the qualitative synthesis. Nine studies were included in the quantitative synthesis. Laparoscopy was associated with lower odds of postoperative complications compared with laparotomy (OR = 0.37; 95% CI: 0.15–0.91). Moderate heterogeneity was observed among the included studies (I 2 = 46.0%). The included studies also reported shorter hospital stays and fewer non-therapeutic laparotomies among selected patients undergoing laparoscopy. In hemodynamically stable patients with penetrating abdominal stab wounds, the laparoscopic approach was associated with lower odds of postoperative complications compared with laparotomy. However, these findings should be interpreted cautiously because the available evidence is predominantly observational and may be influenced by selection and indication bias. Further prospective multicenter studies are needed to clarify the comparative effectiveness and safety of laparoscopic management in this population.