Features of treating patients with penetrating abdominal injuries in healthcare facilities at levels 3-4 of medical care.

BACKGROUND: The treatment of penetrating abdominal wounds at the 3rd and 4th levels of medical care remains insufficiently standardized, and surgical tactics often depend on various factors and the availability of resources. This study analyzes the surgical approaches used at these levels and identifies key factors influencing tactical decision-making. GOALS: Analysis of surgical tactics for the treatment of wounded with penetrating abdominal wounds in medical organizations of 3-4 levels of medical care in conditions of modern armed conflict. METHODS: A retrospective analysis of 142 medical records of wounded with penetrating abdominal wounds was conducted. The patients were divided into three groups depending on the surgical tactics used at levels 3-4: Group No. 1 - follow–up with reconstructive surgery performed at the analyzed level of medical care; group No. 2 – with "second glance" surgery; group No. 3 – without surgery. RESULTS: The factors that significantly determine the need for surgical intervention and statistically significantly influence the choice of surgical tactics were identified: traumatic shock of the second stage (p 0.012), the leading area of injury is the abdomen (p 0.010), peritonitis (p 0.001). The formation of an intestinal anastomosis was performed in 26.5% of the injured with damage to the small intestine and was the predominant method of reconstruction. In case of colon injuries, intestinal stoma was formed (18.3%). Layered suturing is associated with 41.7% of relaparotomies at level 5. Treatment of peritonitis without vacuum aspiration drainage of the abdominal cavity is ineffective in 75% of cases. CONCLUSION: The severity of traumatic shock, the predominance of the leading area of injury - the abdomen and peritonitis are the key factors determining the need for surgical intervention at levels 3-4. The high rate of complications, especially after rectal injury and non-vacuum drainage in peritonitis, indicates an urgent need to standardize treatment protocols in accordance with clinical recommendations to improve outcomes.