Techniques that are considered basic and easy by the trauma surgeons can be unfamiliar and difficult to general surgeons. In this scenario, their operative dexterity and knowledge cannot be compared to that of their trauma surgeon colleagues, something that is taken for granted in the trauma textbooks. Unfortunately, the details included in most of these books are not extensive enough to provide them with enough armamentaria to tackle the difficult case. Most general surgeons have a general knowledge of operating penetrating trauma, knowledge originating from their training years and possibly enhanced by reading operative surgery textbooks. A significant percentage of these patients will not be operated by a trauma surgeon but, by the 'occasional trauma surgeon', who is usually trained as a general surgeon. As a result of that, there is a significant loss of expertise in dealing with this type of injury particularly when the patient presents to theatre with physiological instability. There is a general decline in penetrating abdominal trauma throughout the western world.

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