Incarcerated anterior abdominal wall hernias in a community hospital

Summary

Abdominal wall hernias are among the most common problems encontered by surgeons. It is generally agreed that a hernia should be electively repaired to avoid the complication of incarceration and its attendant risk of strangulation. Nevertheless, many patients remain undiagnosed or are reluctant to have surgical correction of hernias, and as a result many emergency procedures are performed for complications of neglected hernias. We performed a retrospective analysis of incarcerated anterior abdominal wall hernias, and we used multivariate analysis to identify variables that were predictive of gangrenous bowel. There were a total of 1680 anterior abdominal wall hernias during the study period. Surgery was performed emergently for acute incarceration in 132 patients (7.9%), 25% of these were strangulated, and 57.6% of the strangulated cases progressed to gangrene. Femoral hernias had the highest incidence of incarceration and strangulation. Independent predictors of gangrenous bowel were a pulse rate > 100, ASA class four or greater, radiographic evidence of obstruction and the presence of a femoral hernia. The overall mortality rate was 4.5% for the patients with incarceration, and 15.8% for the patients with gangrenous sac contents. The mortality from incarcerated anterior wall hernias has decreased over time, but mortality is still appreciable. Hernias should be repaired electively to avoid the complication of incarceration. The presence of gangrenous bowel can be predicted by a pulse rate > 100, ASA class four or greater, radiographic evidence of obstruction and the presence of a femoral hernia.