Management of blunt traumatic abdominal wall hernias: A Western Trauma Association multicenter study

Kevin N. Harrell; Arthur D. Grimes; Roxie M. Albrecht; Jessica K. Reynolds; Walker R. Ueland; Jason D. Sciarretta; Samual R. Todd; Marc D. Trust; Marielle Ngoue; Bradley W. Thomas; Sullivan A. Ayuso; Aimee LaRiccia; M. Chance Spalding; Michael J. Collins; Bryan R. Collier; Basil S. Karam; Marc A. de Moya; Mark J. Lieser; John M. Chipko; James M. Haan; Kelly L. Lightwine; Daniel C. Cullinane; Carolyne R. Falank; Ryan C. Phillips; Michael T. Kemp; Hasan B. Alam; Pascal O. Udekwu; Gloria D. Sanin; Amy N. Hildreth; Walter L. Biffl; Kathryn B. Schaffer; Gary Marshall; Omaer Muttalib; Jeffry Nahmias; Niti Shahi; Steven L. Moulton; Robert A. Maxwell

doi:10.1097/TA.0000000000003250

Management of blunt traumatic abdominal wall hernias: A Western Trauma Association multicenter study

Kevin N. Harrell^*, Arthur D. Grimes, Roxie M. Albrecht, Jessica K. Reynolds, Walker R. Ueland, Jason D. Sciarretta, Samual R. Todd, Marc D. Trust, Marielle Ngoue, Bradley W. Thomas, Sullivan A. Ayuso, Aimee LaRiccia, M. Chance Spalding, Michael J. Collins, Bryan R. Collier, Basil S. Karam, Marc A. de Moya, Mark J. Lieser, John M. Chipko, James M. HaanKelly L. Lightwine, Daniel C. Cullinane, Carolyne R. Falank, Ryan C. Phillips, Michael T. Kemp, Hasan B. Alam, Pascal O. Udekwu, Gloria D. Sanin, Amy N. Hildreth, Walter L. Biffl, Kathryn B. Schaffer, Gary Marshall, Omaer Muttalib, Jeffry Nahmias, Niti Shahi, Steven L. Moulton, Robert A. Maxwell

^*Corresponding author for this work

Surgery, Trauma and Critical Care Division

Research output: Contribution to journal › Article › peer-review

7 Scopus citations

Abstract

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.

Original language	English (US)
Pages (from-to)	834-840
Number of pages	7
Journal	Journal of Trauma and Acute Care Surgery
Volume	91
Issue number	5
DOIs	https://doi.org/10.1097/TA.0000000000003250
State	Published - Nov 2021

Keywords

Traumatic abdominal wall hernia
abdominal wall injury
blunt abdominal trauma
hernia surgery

ASJC Scopus subject areas

Critical Care and Intensive Care Medicine
Surgery

Access to Document

10.1097/TA.0000000000003250

Cite this

Harrell, K. N., Grimes, A. D., Albrecht, R. M., Reynolds, J. K., Ueland, W. R., Sciarretta, J. D., Todd, S. R., Trust, M. D., Ngoue, M., Thomas, B. W., Ayuso, S. A., LaRiccia, A., Spalding, M. C., Collins, M. J., Collier, B. R., Karam, B. S., de Moya, M. A., Lieser, M. J., Chipko, J. M., ... Maxwell, R. A. (2021). Management of blunt traumatic abdominal wall hernias: A Western Trauma Association multicenter study. Journal of Trauma and Acute Care Surgery, 91(5), 834-840. https://doi.org/10.1097/TA.0000000000003250

@article{0e4c968b85644bf0b178b9ca1ef9c1ae,

title = "Management of blunt traumatic abdominal wall hernias: A Western Trauma Association multicenter study",

abstract = "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.",

keywords = "Traumatic abdominal wall hernia, abdominal wall injury, blunt abdominal trauma, hernia surgery",

author = "Harrell, {Kevin N.} and Grimes, {Arthur D.} and Albrecht, {Roxie M.} and Reynolds, {Jessica K.} and Ueland, {Walker R.} and Sciarretta, {Jason D.} and Todd, {Samual R.} and Trust, {Marc D.} and Marielle Ngoue and Thomas, {Bradley W.} and Ayuso, {Sullivan A.} and Aimee LaRiccia and Spalding, {M. Chance} and Collins, {Michael J.} and Collier, {Bryan R.} and Karam, {Basil S.} and {de Moya}, {Marc A.} and Lieser, {Mark J.} and Chipko, {John M.} and Haan, {James M.} and Lightwine, {Kelly L.} and Cullinane, {Daniel C.} and Falank, {Carolyne R.} and Phillips, {Ryan C.} and Kemp, {Michael T.} and Alam, {Hasan B.} and Udekwu, {Pascal O.} and Sanin, {Gloria D.} and Hildreth, {Amy N.} and Biffl, {Walter L.} and Schaffer, {Kathryn B.} and Gary Marshall and Omaer Muttalib and Jeffry Nahmias and Niti Shahi and Moulton, {Steven L.} and Maxwell, {Robert A.}",

year = "2021",

month = nov,

doi = "10.1097/TA.0000000000003250",

language = "English (US)",

volume = "91",

pages = "834--840",

journal = "Journal of Trauma and Acute Care Surgery",

issn = "2163-0755",

publisher = "Lippincott Williams and Wilkins",

number = "5",

}

Harrell, KN, Grimes, AD, Albrecht, RM, Reynolds, JK, Ueland, WR, Sciarretta, JD, Todd, SR, Trust, MD, Ngoue, M, Thomas, BW, Ayuso, SA, LaRiccia, A, Spalding, MC, Collins, MJ, Collier, BR, Karam, BS, de Moya, MA, Lieser, MJ, Chipko, JM, Haan, JM, Lightwine, KL, Cullinane, DC, Falank, CR, Phillips, RC, Kemp, MT, Alam, HB, Udekwu, PO, Sanin, GD, Hildreth, AN, Biffl, WL, Schaffer, KB, Marshall, G, Muttalib, O, Nahmias, J, Shahi, N, Moulton, SL & Maxwell, RA 2021, 'Management of blunt traumatic abdominal wall hernias: A Western Trauma Association multicenter study', Journal of Trauma and Acute Care Surgery, vol. 91, no. 5, pp. 834-840. https://doi.org/10.1097/TA.0000000000003250

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.

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 - Traumatic abdominal wall hernia

KW - abdominal wall injury

KW - blunt abdominal trauma

KW - hernia surgery

UR - http://www.scopus.com/inward/record.url?scp=85120838142&partnerID=8YFLogxK

UR - http://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 -

Management of blunt traumatic abdominal wall hernias: A Western Trauma Association multicenter study

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this