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Surgery for incarcerated hernia: short-term outcome with or without mesh

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Abstract

Background

Incarcerated hernias represent about 5–15 % of all operated hernias. Tension-free mesh is the preferred technique for elective surgery due to low recurrence rates. There is however currently no consensus on the use of mesh for the treatment of incarcerated hernias, especially in case of bowel resection.

Aim

The aims of this study were (i) to report our current practice for the treatment of incarcerated hernias, (ii) to identify risk factors for postoperative complications, and (iii) to assess the safety of mesh placement in potentially infected surgical fields.

Methods

This retrospective study included 166 consecutive patients who underwent emergency surgery for incarcerated hernia between January 2007 and January 2012 in two university hospitals. Demographics, surgical details, and short-term outcome were collected. Univariate analysis was employed to identify risk factors for overall, infectious, and major complications.

Results

Eighty-four patients (50.6 %) presented inguinal hernias, 43 femoral (25.9 %), 37 umbilical hernias (22.3 %), and 2 mixed hernias (1.2 %), respectively. Mesh was placed in 64 patients (38.5 %), including 5 patients with concomitant bowel resection. Overall morbidity occurred in 56 patients (32.7 %), and 8 patients (4.8 %) developed surgical site infections (SSI). Univariate risk factors for overall complications were ASA grade 3/4 (P = 0.03), diabetes (P = 0.05), cardiopathy (P = 0.001), aspirin use (P = 0.023), and bowel resection (P = 0.001) which was also the only identified risk factor for SSI (P = 0.03). In multivariate analysis, only bowel incarceration was associated with a higher rate of major morbidity (OR = 14.04; P = 0.01).

Conclusion

Morbidity after surgery for incarcerated hernia remains high and depends on comorbidities and surgical presentation. The use of mesh could become current practice even in case of bowel resection.

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References

  1. Gallegos NC, Dawson J, Jarvis M, Hobsley M (1991) Risk of strangulation in groin hernias. Br J Surg 78:1171–1173

    Article  CAS  PubMed  Google Scholar 

  2. Kulah B, Kulacoglu IH, Oruc MT, Duzgun AP, Moran M, Ozmen MM, Coskun F (2001) Presentation and outcome of incarcerated external hernias in adults. Am J Surg 181:101–104

    Article  CAS  PubMed  Google Scholar 

  3. Kurt N, Oncel M, Ozkan Z, Bingul S (2003) Risk and outcome of bowel resection in patients with incarcerated groin hernias: retrospective study. World J Surg 27:741–743

    Article  PubMed  Google Scholar 

  4. Derici H, Unalp HR, Nazli O, Kamer E, Coskun M, Tansug T, Bozdag AD (2010) Prosthetic repair of incarcerated inguinal hernias: is it a reliable method? Langenbecks Arch Surg 395:575–579

    Article  PubMed  Google Scholar 

  5. Mathonnet M, Mehinto D (2007) Anterolateral hernias of the abdomen. J Chir 144(4):5S19–5S22

    Article  Google Scholar 

  6. Jenkins JT, O’Dwyer PJ (2008) Inguinal hernia. BMJ 336:268–272

    Article  Google Scholar 

  7. Danielsson P, Isacson S, Hansen MV (1999) Randomised study of Lichtenstein compared with Shouldice inguinal hernia repair by surgeons in training. Eur J Surg 165:49–53

    Article  CAS  PubMed  Google Scholar 

  8. McGillicuddy JE (1998) Prospective randomized comparison of the Shouldice and Lichtenstein hernia repair procedures. Arch Surg 133:974–978

    Article  CAS  PubMed  Google Scholar 

  9. Butters M, Redecke J, Köninger J (2007) Long-term results of a randomized clinical trial of Shouldice, Lichtenstein and transabdominal preperitoneal hernia repairs. Br J Surg 94:562–565

    Article  CAS  PubMed  Google Scholar 

  10. Bisgaard T, Bay-Nielsen M, Christensen IJ, Kehlet H (2007) Risk of recurrence 5 years or more after primary Lichtenstein mesh and sutured inguinal hernia repair. Br J Surg 94:1038–1040

    Article  CAS  PubMed  Google Scholar 

  11. Elsebae MMA, Nasr M, Said M (2008) Tension free repair versus Bassini technique for strangulated inguinal hernia: a controlled randomized study. Int J Surg 6:302–305

    Article  PubMed  Google Scholar 

  12. Pans A, Desive C, Jacquet N (1997) Use of a preperitoneal prosthesis for strangulated groin hernia. Br J Surg 84:310–312

    Article  CAS  PubMed  Google Scholar 

  13. Lohsiriwat V, Sridermma W, Akaraviputh T, Boonnuch W, Chinsawangwatthanakol V, Methasate A et al (2007) Surgical outcomes of Lichtenstein tension-free hernioplasty for acutely incarcerated hernia. Surg Today 37:212–214

    Article  PubMed  Google Scholar 

  14. Lohsiriwat D, Lohsiriwat S (2013) Long-term outcomes of emergency Lichtenstein hernioplasty for incarcerated inguinal hernia. Surg Today 43:990–994

    Article  PubMed  Google Scholar 

  15. Atila K, Guler S, Inal A, Sokmen S, Karademir S, Bora S (2010) Prosthetic repair of acutely incarcerated groin hernias: a prospective clinical observational cohort study. Langenbecks Arch Surg 395:563–568

    Article  PubMed  Google Scholar 

  16. Ueda J, Nomura T, Sasaki et al (2012) Prosthetic repair of an incarcerated groin hernia with small intestinal resection. Surg Today 42:359–362

  17. Garner JS (1986) CDC guideline for prevention of surgical wound infections, 1985. Supercedes guideline for prevention of surgical wound infection published in 1982. Revised Infect Control 7:193–200

    CAS  Google Scholar 

  18. Simmons BP (1982) Guideline for prevention of surgical wound infections. Infect Control 3:185–196

    Google Scholar 

  19. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR (1999) Guideline for prevention of surgical site infection, 1999. Center for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 27:97–132

  20. Pélissier E, Ngo P (2007) Traitement des hernies de l’aine étranglées. EMC. Elsevier Masson SAS, Paris, Techniques chirurgicales- Appareil digestif, 40–139

  21. Expert Panel on the Identification, Evaluation and Treatment of Overweight in adult (1998) Clinical guidelines on the identification, evaluation and treatment of overweight and obesity in adults: executive summary: expert panel on the identification, evaluation and treatment of overweight in adults. Am J Clin Nutr 68:899–917

  22. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications. A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 244:931–937

    Google Scholar 

  23. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG (1992) CDC definitions of nosocomial surgical site infection, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 13:606–608

    Article  CAS  PubMed  Google Scholar 

  24. Romain B, Chemaly R, Meyer N, Brigand C, Steinmetz JP, Rohr S (2012) Prognostic factors of postoperative morbidity and mortality in strangulated groin hernia. Hernia 16:405–410

    Article  CAS  PubMed  Google Scholar 

  25. Derici H, Unalp HR, Bozdag AD, Nazli TT, Kamer E (2007) Factors affecting morbidity and mortality in abdominal wall hernias. Hernia 11:341–346

    Article  CAS  PubMed  Google Scholar 

  26. Martinez-Serrano MA, Pereira JA, Sancho J, Argudo N, Lopez-Cano M, Grande L (2012) Specific improvement measures to reduce complications and mortality after urgent surgery in complicated abdominal wall hernia. Hernia 16:171–177

    Article  CAS  PubMed  Google Scholar 

  27. Bessa SS, Abdel-Razek AH (2013) Results of prosthetic mesh repair in the emergency management of the acutely or strangulated ventral hernias: a seven years study. Hernia 17:59–65

    Article  CAS  PubMed  Google Scholar 

  28. Matinez-Serrano MA, Pereira JA, Sancho JJ, Lopez-Cano J, Bombuy E, Hidlago J et al (2010) Risk of death after emergency repair of abdominal wall hernias. Still waiting for improvement. Langenbecks Arch Surg 395:551–556

    Article  Google Scholar 

  29. Kwaan MR, Al-Refaie WB, Parsons HM, Chow CJ, Rothenberger DA, Habermann EB (2013) Are right-sided colectomy outcomes different from left-sided colectomy outcomes?: study of patients with colon cancer in the ACS NSQIP database. JAMA Surg 148:504–510

    Article  PubMed  Google Scholar 

  30. Papaziogas B, Lazaridis C, Makris J, Koutelidakis J, Patsas A, Grigoriou M, Chatzimavroudis G, Psaralexis K, Atmatzidis K (2005) Tension-free repair versus modified Bassini technique (Andrews technique) for strangulated inguinal hernia: a comparative study. Hernia 9:156–159

    Article  CAS  PubMed  Google Scholar 

  31. Wysocki A, Kulawik J, Pozniczek M, Strzalka M (2006) Is the Lichtenstein operation of strangulated groin hernia a safe procedure? World J Surg 30:2065–2070

    Article  PubMed  Google Scholar 

  32. Bessa SS, Katri KM, Abdel-Salam WN, Abdel-Baki NA (2007) Early results from the use of the Liechtenstein repair in the management of strangulated groin hernia. Hernia 11:239–242

    Article  CAS  PubMed  Google Scholar 

  33. Abdel-Baki NA, Bessa SS, Abdel-Razek AH (2007) Comparison of prosthetic mesh repair and tissue repair in the emergency management of incarcerated para-umbilical hernia: a prospective randomized study. Hernia 11:163–167

    Article  CAS  PubMed  Google Scholar 

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Conflicts of interest

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Authors and Affiliations

  1. Visceral and Endocrine Surgery Department, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France

    A. Venara, P. Le Naoures & A. Hamy

  2. Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland

    A. Venara, M. Hubner & N. Demartines

  3. L’UNAM, University of Angers, Angers, France

    P. Le Naoures, J. F. Hamel & A. Hamy

  4. Department of Methodology and Biostatistics, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France

    J. F. Hamel

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  1. A. Venara
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  2. M. Hubner
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  3. P. Le Naoures
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  4. J. F. Hamel
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  5. A. Hamy
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Correspondence to A. Venara.

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A. Venara and M. Hubner have shared first authorship.

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Venara, A., Hubner, M., Le Naoures, P. et al. Surgery for incarcerated hernia: short-term outcome with or without mesh. Langenbecks Arch Surg 399, 571–577 (2014). https://doi.org/10.1007/s00423-014-1202-x

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  • DOI: https://doi.org/10.1007/s00423-014-1202-x

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