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Traumatic abdominal wall hernias: Location matters

Coleman, Jamie J. MD; Fitz, Evan K. MD; Zarzaur, Ben L. MD, MPH; Steenburg, Scott D. MD; Brewer, Brian L. MD; Reed, R. Lawrence MD; Feliciano, David V. MD

Journal of Trauma and Acute Care Surgery: March 2016 - Volume 80 - Issue 3 - p 390–397
doi: 10.1097/TA.0000000000000946
AAST 2015 Plenary Papers
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BACKGROUND Because of its uncommon nature and a lack of comprehensive literature, abdominal wall hernias caused by blunt trauma continue to present a management dilemma. This study was performed to identify the incidence of associated injuries, the need for urgent operative intervention, and recurrence rates after hernia repair.

METHODS A retrospective review of patients diagnosed with a traumatic abdominal wall hernia from January 2002 to December 2014 was performed. Data were collected from the trauma registry and included patient demographics, location and type of hernia, associated injuries, operative interventions, complications, and length of stay.

RESULTS Eighty patients (64% male; median age, 36 years; mean Injury Severity Score [ISS], 22) were identified during the study period. A motor vehicle collision was the most frequent mechanism of injury (n = 58). Overall, 35 patients (44%) underwent urgent laparotomy or laparoscopy, and 10 of these (29%) were nontherapeutic excluding hernia repair. Of interest, 17 patients (49%) required bowel resection. Notably, the need for operative intervention and nontherapeutic rate differed depending on hernia location. Hernia repair was performed in 23 patients, the majority of whom (78.3%) underwent repair within 5 days of injury. There were six recurrences, four of which were repaired acutely (within 1 week of injury), with an overall first-time hernia recurrence rate of 26%.

CONCLUSION In the largest series to date, traumatic abdominal wall hernias were found to be associated with a high percentage of intra-abdominal injuries requiring urgent laparotomy or laparoscopy. Rates of therapeutic interventions varied by hernia location, with anterior abdominal hernias associated with the highest need for a therapeutic operation. Acute repair was associated with the majority of the recurrences.

LEVEL OF EVIDENCE Epidemiologic study, level III; therapeutic study, level IV.

From the Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.

Submitted: September 3, 2015, Revised: November 8, 2015, Accepted: November 9, 2015, Published online: December 26, 2015.

This study was presented at the 74th annual meeting of the American Association for the Surgery of Trauma, September 9–12, 2015, in Las Vegas, Nevada.

Address for reprints: Jamie J. Coleman, MD, 1604 N. Capitol Avenue, Office B242, Indiana University, Indianapolis, Indiana 46202; email: jamjcole@iupui.edu.

© 2016 Lippincott Williams & Wilkins, Inc.