TY - JOUR
T1 - Management of blunt traumatic abdominal wall hernias
T2 - A Western Trauma Association multicenter study
AU - Harrell, Kevin N.
AU - Grimes, Arthur D.
AU - Albrecht, Roxie M.
AU - Reynolds, Jessica K.
AU - Ueland, Walker R.
AU - Sciarretta, Jason D.
AU - Todd, Samual R.
AU - Trust, Marc D.
AU - Ngoue, Marielle
AU - Thomas, Bradley W.
AU - Ayuso, Sullivan A.
AU - LaRiccia, Aimee
AU - Spalding, M. Chance
AU - Collins, Michael J.
AU - Collier, Bryan R.
AU - Karam, Basil S.
AU - de Moya, Marc A.
AU - Lieser, Mark J.
AU - Chipko, John M.
AU - Haan, James M.
AU - Lightwine, Kelly L.
AU - Cullinane, Daniel C.
AU - Falank, Carolyne R.
AU - Phillips, Ryan C.
AU - Kemp, Michael T.
AU - Alam, Hasan B.
AU - Udekwu, Pascal O.
AU - Sanin, Gloria D.
AU - Hildreth, Amy N.
AU - Biffl, Walter L.
AU - Schaffer, Kathryn B.
AU - Marshall, Gary
AU - Muttalib, Omaer
AU - Nahmias, Jeffry
AU - Shahi, Niti
AU - Moulton, Steven L.
AU - Maxwell, Robert A.
N1 - Publisher Copyright:
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2021/11
Y1 - 2021/11
N2 - BACKGROUND: Blunt traumatic abdominal wall hernias (TAWH) occur in approximately 15,000 patients per year. Limited data are available to guide the timing of surgical intervention or the feasibility of nonoperative management. METHODS: A retrospective study of patients presenting with blunt TAWH from January 2012 through December 2018 was conducted. Patient demographic, surgical, and outcomes data were collected from 20 institutions through the Western Trauma Association Multicenter Trials Committee. RESULTS: Two hundred and eighty-one patients with TAWH were identified. One hundred and seventy-six (62.6%) patients underwent operative hernia repair, and 105 (37.4%) patients underwent nonoperative management. Of those undergoing surgical intervention, 157 (89.3%) were repaired during the index hospitalization, and 19 (10.7%) underwent delayed repair. Bowel injury was identified in 95 (33.8%) patients with the majority occurring with rectus and flank hernias (82.1%) as compared with lumbar hernias (15.8%). Overall hernia recurrence rate was 12.0% (n = 21). Nonoperative patients had a higher Injury Severity Score (24.4 vs. 19.4, p = 0.010), head Abbreviated Injury Scale score (1.1 vs. 0.6, p = 0.006), and mortality rate (11.4% vs. 4.0%, p = 0.031). Patients who underwent late repair had lower rates of primary fascial repair (46.4% vs. 77.1%, p = 0.012) and higher rates of mesh use (78.9% vs. 32.5%, p < 0.001). Recurrence rate was not statistically different between the late and early repair groups (15.8% vs. 11.5%, p = 0.869). CONCLUSION: This report is the largest series and first multicenter study to investigate TAWHs. Bowel injury was identified in over 30% of TAWH cases indicating a significant need for immediate laparotomy. In other cases, operative management may be deferred in specific patients with other life-threatening injuries, or in stable patients with concern for bowel injury. Hernia recurrence was not different between the late and early repair groups.
AB - BACKGROUND: Blunt traumatic abdominal wall hernias (TAWH) occur in approximately 15,000 patients per year. Limited data are available to guide the timing of surgical intervention or the feasibility of nonoperative management. METHODS: A retrospective study of patients presenting with blunt TAWH from January 2012 through December 2018 was conducted. Patient demographic, surgical, and outcomes data were collected from 20 institutions through the Western Trauma Association Multicenter Trials Committee. RESULTS: Two hundred and eighty-one patients with TAWH were identified. One hundred and seventy-six (62.6%) patients underwent operative hernia repair, and 105 (37.4%) patients underwent nonoperative management. Of those undergoing surgical intervention, 157 (89.3%) were repaired during the index hospitalization, and 19 (10.7%) underwent delayed repair. Bowel injury was identified in 95 (33.8%) patients with the majority occurring with rectus and flank hernias (82.1%) as compared with lumbar hernias (15.8%). Overall hernia recurrence rate was 12.0% (n = 21). Nonoperative patients had a higher Injury Severity Score (24.4 vs. 19.4, p = 0.010), head Abbreviated Injury Scale score (1.1 vs. 0.6, p = 0.006), and mortality rate (11.4% vs. 4.0%, p = 0.031). Patients who underwent late repair had lower rates of primary fascial repair (46.4% vs. 77.1%, p = 0.012) and higher rates of mesh use (78.9% vs. 32.5%, p < 0.001). Recurrence rate was not statistically different between the late and early repair groups (15.8% vs. 11.5%, p = 0.869). CONCLUSION: This report is the largest series and first multicenter study to investigate TAWHs. Bowel injury was identified in over 30% of TAWH cases indicating a significant need for immediate laparotomy. In other cases, operative management may be deferred in specific patients with other life-threatening injuries, or in stable patients with concern for bowel injury. Hernia recurrence was not different between the late and early repair groups.
KW - abdominal wall injury
KW - blunt abdominal trauma
KW - hernia surgery
KW - Traumatic abdominal wall hernia
UR - https://www.scopus.com/pages/publications/85120838142
UR - https://www.scopus.com/inward/citedby.url?scp=85120838142&partnerID=8YFLogxK
U2 - 10.1097/TA.0000000000003250
DO - 10.1097/TA.0000000000003250
M3 - Article
C2 - 34695060
AN - SCOPUS:85120838142
SN - 2163-0755
VL - 91
SP - 834
EP - 840
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 5
ER -