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Comparison of emergent laparoscopic and open repair of acutely incarcerated and strangulated hernias—short- and long-term results

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Abstract

Background

Incarcerated and strangulated hernias are a common clinical presentation encompassing several challenges in acute care surgery. The role of laparoscopy is still controversial and the data is scarce. Laparoscopy enables better evaluation of the incarcerated organ and its viability. The use of mesh repair in these emergent operations is also a major concern. In this series we aimed to evaluate the safety and efficacy of laparoscopic emergent repairs of acutely incarcerated and strangulated hernias, and their long-term results, in comparison to the conventional open repairs.

Methods

Retrospective review of prospectively collected data of all adult patients, between the ages of 18 and 89, who underwent emergent operation due to an incarcerated and strangulated hernia between November 2017 and December 2020.

Results

During the study period, 89 patients underwent emergent operation due to incarcerated hernias-63 laparoscopic repair and 26 underwent an open repair. In the laparoscopic group (LG) 38 patients had a groin hernia and 25 had a ventral hernia, while in the open group (OG) the distribution was 12 and 14, respectively. When operated laparoscopically, all groin hernias but one were repaired in the TAPP approach and most ventral hernias were repaired using the IPOM + approach. During the peri-operative period there were 3 mortalities (1 in the LG). There were no significant differences between the groups in minor or major complications. Mean follow-up time in the LG was 27.9 months and 29.4 months in the OG. There was no significant difference in recurrence rates. Long-term results showed better outcome in the LG regarding pain at rest, difficulty doing exercise and local discomfort.

Conclusion

Laparoscopic emergent repair of incarcerated hernias is a safe and feasible approach, with better short and long-term results compared to the open approach.

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Availability of data and materials

Raw data were generated at Assuta Medical center. Derived data supporting the findings of this study are available from the corresponding author on request.

Code availability

Not applicable.

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Authors and Affiliations

  1. General Surgery Department, Assuta Ashdod Medical Center, Harefua 7, 7747629, Ashdod, Israel

    Rachmuth Jacob, Steinberg-Barkon Guy, Carmeli Idan, Rayman Shlomi & Mnouskin Youri

  2. The Hebrew University of Jerusalem, Jerusalem, Israel

    Lee Kamila

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  2. Steinberg-Barkon Guy
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  3. Lee Kamila
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by JR, GS-B, KL and SR. The first draft of the manuscript was written by JR and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Rachmuth Jacob.

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Disclosures

Jacob Rachmuth, Guy Steinberg-Barkon, Kamila Lee, Idan Carmeli, Shlomi Rayman and Youri Mnouskin declare that they have no conflict of interest or financial ties to disclose.

Ethical approval

The questionnaire and methodology for this study was approved by the Human Research Ethics committee of the Assuta Ashdod Medical center (Ethics Approval Number 0012–19-AAA).

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Informed consent was obtained from all individual participants included in the study.

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Patients consented to publishing their data.

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Jacob, R., Guy, SB., Kamila, L. et al. Comparison of emergent laparoscopic and open repair of acutely incarcerated and strangulated hernias—short- and long-term results. Surg Endosc 37, 2154–2162 (2023). https://doi.org/10.1007/s00464-022-09743-4

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