Highlights from #AAST2015 - Traumatic Abdominal Wall Hernias

Former resident Jamie Coleman presented a series of Traumatic Abdominal Wall hernias.  They don't necessarily need to be repaired.

TRAUMATIC ABDOMINAL WALL HERNIAS: LOCATION MATTERS

Jamie J. Coleman MD, Evan Fitz MD, Ben Zarzaur* MD,MPH, Scott Steenburg MD, Brian Brewer MD, David Feliciano* MD, Timothy Pohlman MD, Robert Reed* MD, Grace Rozycki* MBA,MD, Indiana Univesity School of Medicine

Introduction: Abdominal wall hernias resulting from blunt trauma are uncommon and often have several layers of tissue destruction. They present a unique reconstructive challenge and optimal management is unclear. This study was performed to identify the incidence of associated injuries, the need for urgent operative intervention, and hernia recurrence rates.

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, length of stay, location and type of hernia, operative interventions, and complications.

Results: Eighty patients (64% Male; Median Age 36; Mean ISS = 22) were identified during the study period. Motor vehicle collision (MVC) was the most frequent mechanism of injury

(n= 58). Overall, 36 patients (45%) underwent urgent laparotomy or laparoscopy, and 8 (22%) were non-therapeutic excluding acute hernia repair. Of interest, 19 (53%) required bowel resection. Notably, the need for operative intervention and non-therapeutic rate differed depending upon hernia location (Figure). Twenty-three patients underwent hernia repair, the majority of which (78.3%) were repaired within five days of injury. There were six recurrences, four of which were repaired acutely, with an overall first time hernia recurrence rate of 26.1%.

Conclusion: In the largest series to date, we found traumatic abdominal wall hernias 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 wall hernias associated with the highest need for a therapeutic operation. Acute repair was associated with the majority of recurrences.