Introduction: Peritoneal violation as an indication for surgery in anterior abdominal stab wounds (SW) is known to be associated with significant non-therapeutic exploration, but remains a common practice. This study reviews our experience in a high resource but low penetrating injury volume centre in New Zealand. Materials and Methods: A retrospective study was conducted over a 20-year period from 2004-2024 and included all patients with anterior abdominal SWs treated at Auckland City Hospital. Results: A total of 182 patients were included. 98 (54%) proceeded directly to surgery due to haemodynamic instability, peritonitis, evisceration and / or high suspicion of intra-abdominal injury. The remaining 84 patients all underwent CT. 33 did not show evidence of peritoneal breach and the other 51 demonstrated peritoneal violation. Of the 51 patients who demonstrated peritoneal violation on CT, 28 (55%) had associated organ injury, and the remaining 23 (45%) demonstrated peritoneal violation alone. 49 of the 51 patients underwent surgery. 38 proceed to laparotomy, all of which were positive (28 therapeutic, 10 non-therapeutic). 5 underwent laparoscopy which required conversion to laparotomy, all 5 of which were positive (4 therapeutic and 1 non-therapeutic). 6 underwent laparoscopy that did not require conversion. 4 were positive (3 therapeutic and 1 non-therapeutic) and 2 were negative. Overall, 47 (96%) were positive for injury and the remaining 2 (4%) was negative. Of the 47 positive cases, 35 (74%) were considered therapeutic and the remaining 12 (26%) were non-therapeutic. The overall morbidity was 16% and the mortality was 0%. Conclusions: Peritoneal violation remains an indication for surgery, which not changed over the past decade and was associated with high rates of positive exploration. It would appear that this approach remains appropriate in our environment over the past two decades and is associated with significant non-therapeutic rate at surgery.