Laparoscopic-assisted management of traumatic abdominal wall hernias in children: case series and a review of the literature.
BACKGROUND
Traumatic abdominal wall hernia (TAWH) is defined as herniation through a disrupted portion of musculature/fascia without skin penetration or history of prior hernia. In children, TAWH is a rare injury.


OBJECTIVE
The objectives of this study were to report our experience with different management strategies of TAWH in children and to determine the utility of laparoscopy.


METHODS
A retrospective chart review of all children treated by pediatric surgery at our institution for TAWH in a 5year interval was performed. Data were collected on mechanism of injury, initial patient presentation, surgical management, and outcomes.


RESULTS
We present 5 cases of traumatic abdominal wall hernia; 3 were managed using laparoscopic assistance. One patient was managed nonoperatively. All patients recovered without complications and were asymptomatic on follow up.


CONCLUSIONS
Traumatic abdominal wall hernias require a high index of suspicion in the cases of blunt abdominal trauma. Laparoscopy is useful mainly as a diagnostic modality, both to evaluate the hernia and associated injuries to intraabdominal structures. Its use may facilitate repair through a smaller incision. Conservative management of TAWH may be appropriate in select cases where there is a low risk of bowel strangulation.
Department of General Surgery, Boston University, 88 East Newton Street, C515, Boston, MA, 02118, USA. Electronic address: Stephanie.Talutis@bmc.org.
Stephanie D
SD
Talutis
Division of Pediatric Surgery, Montefiore Medical Center, 3400 Bainbridge Avenue, Medical Arts Pavilion, Room 4th Floor, Bronx, NY 10467, USA.
Oliver J
OJ
Muensterer
Division of Pediatric Surgery, New York Medical College, Maria Fareri Children's Hospital, Skyline A14, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA.
Samir
S
Pandya
Division of Pediatric Surgery, New York Medical College, Maria Fareri Children's Hospital, Skyline A14, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA.
Whitney
W
McBride
Division of Pediatric Surgery, New York Medical College, Maria Fareri Children's Hospital, Skyline A14, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA.
Gustavo
G
Stringel
D000007:Abdominal Injuries / Q000150:complications / Q000628:therapy; D034861:Abdominal Wall; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D005260:Female; D046449:Hernia, Abdominal / Q000209:etiology / Q000628:therapy*; D006555:Hernia, Ventral / Q000209:etiology / Q000628:therapy; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D012189:Retrospective Studies; D014945:Wound Healing; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000628:therapy
Abdominal wall hernia; Children; Handlebar injury; Laparoscopy; Trauma