Blunt Traumatic Abdominal Wall Hernias: An Indicator for Emergent Laparotomy?

BACKGROUND: Traumatic abdominal wall hernias (TAWH) are relatively uncommon; however, the shearing force that results in fascial disruption could indicate an increased risk of visceral injury. The aim of our study was to evaluate whether the presence of a TAWH was associated with intra-abdominal injury requiring emergent laparotomy. METHODS: The trauma registry was queried over an 8-year period (7/2012-7/2020) for adult patients with blunt thoracoabdominal trauma diagnosed with a TAWH. Those patients who were identified with a TAWH and greater than 15 years of age were included in the study. Demographics, mechanism of injury, ISS, BMI, length of stay, TAWH size, type of TAWH repair, and outcomes were analyzed. RESULTS: Overall, 38,749 trauma patients were admitted over the study period, of which 64 (.17%) had a TAWH. Patients were commonly male (n = 42, 65.6%); the median age was 39 years (range 16-79 years) and a mean ISS of 21. Twenty-eight percent had a clinical seatbelt sign. Twenty-seven (42.2%) went emergently to the operating room, the majority for perforated viscus requiring bowel resection (n = 16, 25.0%), and 6 patients (9.4%) who were initially managed nonoperatively underwent delayed laparotomy. Average ventilator days was 14 days, with a mean ICU LOS of 14 days and mean hospital LOS of 18 days. About half of the hernias were repaired at the index operation, 6 of which were repaired primarily and 10 with mesh. CONCLUSION: The presence of a TAWH alone was an indication for immediate laparotomy to evaluate for intra-abdominal injury. In the absence of other indications for exploration, nonoperative management may be safe.

Trends in resident operative trauma: How to train future trauma surgeons?

BACKGROUND: Trauma is an essential content area of general surgery residency. The objective of this study was to assess trends in the operative trauma experience by general surgery residents. METHODS: This was a retrospective review of available ACGME case log reports (the past 29 years) for general surgery residents. RESULTS: Over the study period, the total operative trauma cases as surgeon decreased from 79.6 to 29.9, (p < 0.001), gastrointestinal cases decreased from 10.6 to 4.0, (p < 0.001), and vascular cases decreased from 8.6 to 4.5, (p < 0.001). The median number of trauma cases in which residents reported a teaching assistant role fell from 5 to 1 (p < 0.001) and as a first assistant declined from 17 to 1 (p < 0.001). CONCLUSIONS: Over the past 29 years, the operative trauma experience of general surgery residents has dramatically decreased. The decline is multifactorial but brings sharp focus on resident education in operative trauma.