title: Intraoperative management of renal gunshot injuries: is mandatory exploration of Gerota's fascia necessary?
abstract: BACKGROUND
  Many trauma surgeons and trauma centers use routine exploration of Gerota's fascia (GE) for renal gunshot wounds (RGSW). The purpose of this study was to assess whether RGSW can be selectively explored for patients who undergo exploratory laparotomy.
  
  
  METHODS
  Retrospective 10-year review of all patients who underwent exploratory laparotomy for abdominal gunshot wounds and had RGSW selectively explored.
  
  
  RESULTS
  Sixty-three patients with RGSW underwent exploratory laparotomy. Twenty-eight (44%) underwent GE vs 35 (56%) who did not. Eight (29%) mortalities occurred with GE and 5 (14%) without GE (P < .05). Of GE patients, 14 (50%) had nephrectomy and 14 (50%) had renorrhaphy. Average hospital length of stay with GE was 16.7 days vs 17.9 without GE. Three (9%) renal-associated complications occurred without GE and 1 (4%) with GE.
  
  
  CONCLUSIONS
  Most patients who suffer RGSW do not require exploration of GE during abdominal exploration. Complication rates due to nonexploration of RGSW are very low with infrequent need for surgical intervention due to renal-associated complications. High nephrectomy rates may be avoided when GE is averted.
authors: Division of Trauma, Surgical Critical Care and Acute Care Surgery, Department of Surgery, University of South Alabama, Mobile, AL, USA.
authors: Jack
authors: J
authors: Rostas
authors: Division of Trauma, Surgical Critical Care and Acute Care Surgery, Department of Surgery, University of South Alabama, Mobile, AL, USA.
authors: Jon D
authors: JD
authors: Simmons
authors: Department of Surgery, Texas Health Presbyterian, Dallas, TX, USA.
authors: Mohommad A
authors: MA
authors: Frotan
authors: Division of Trauma, Surgical Critical Care and Acute Care Surgery, Department of Surgery, University of South Alabama, Mobile, AL, USA.
authors: Sidney B
authors: SB
authors: Brevard
authors: Division of Trauma, Department of Surgery, Surgical Critical Care and Burns, Loyola University Medical Center, Maywood, IL, USA. Electronic address: richard.gonzalez@lumc.edu.
authors: Richard P
authors: RP
authors: Gonzalez
mesh_terms: D000328:Adult; D005205:Fascia / Q000293:injuries; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D007668:Kidney / Q000293:injuries*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014948:Wounds, Gunshot / Q000401:mortality / Q000601:surgery*
keywords: Exploration; Gunshot; Management; Operative; Renal; Wound