Objective: In this five-year study, we aimed at investigating the factors related to strangulation and mortality in patients who underwent urgent surgery to treat incarcerated abdominal wall hernias.
Methods: Patients presenting to the emergency department with an incarcerated abdominal wall hernia (incisional, umbilical, femoral, or inguinal) between October 2015and October 2019 were included in the study. The presence of intraoperative ischemia and necrosis was defined as “strangulation.” Depending on the presence or absence of strangulation in the incarcerated segment, patients were divided into two groups: Group 1 (nonstrangulated) and Group 2 (strangulated). Between the groups, length of time between incarceration and hospital admission, demographic and clinical data, and physical examination findings, Risk factors for strangulation and mortality were determined with univariate and multivariate analyses.
Results: A total of 161 patients were enrolled in the study. Group 1 consisted of 119 patients and Group 2 consisted of 42 patients. In multivariate analysis, the prominent risk factors for strangulation were: high ASA score (p=0.008), acute abdomen findings with distension and elevated body temperature (p<0.001), delayed hospital admission (p<0.001), procalcitonin >0.5 ng/ml (p<0.001), D-Dimer > 500 µg/L (p<0.001), lactate > 2 mmol/L (p<0.001),and creatinine levels > 2 mg/dl (p<0.001). For mortality, the presence of strangulation (p<0.001), lactate levels > 2 mg/dl (p=0.004), and ASA scores > 3 (p =0.035) were the leading risk factors.
Conclusion: The most significant risk factors for strangulation were delay of more than 48 hours, high procalcitonin, creatinine, lactate and D-Dimer levels while for mortality, strangulation, high lactate and ASA levels were significantly effective. Mortality rates may be lowered with an earlier diagnosis, more specifically, one made before the development of metabolic and radiologic impairment.
- Ozkan E, Yıldız MK, Cakır T, Dulundu E, Eriş C, Fersahoğlu MM, et al. Incarcerated abdominal wall hernia surgery: relationship between risk factors and morbidity and mortality rates (a single center emergency surgery experience). Ulus Travma Acil Cerrahi Derg. 2012;18(5):389–96. doi: 10.5505/tjtes.2012.48827 . [PMID: 23188599]
- Gul M, Aliosmanoglu I, Kapan M, Onder A, Taskesen F, Arikanoglu Z, et al. Factors affecting morbidity and mortality in patients who underwent emergency operation for incarcerated abdominal wall hernia. Int Surg. 2012;97(4):305–9. doi: 10.9738/CC114.1 . [PMID: 23294070]
- Martínez-Serrano MA, Pereira JA, Sancho JJ, López-Cano M, Bombuy E, Hidalgo J, et al. Risk of death after emergency repair of abdominal wall hernias. Still waiting for improvement. Langenbeck’s Arch Surg. 2010;395(5):551–6. doi: 10.1007/s00423-009-0515-7 . [PMID: 19513743]
- Bay-Nielsen M, Kehlet H, Strand L, Malmstrøm J, Andersen FH, Wara P, et al. Quality assessment of 26,304 herniorrhaphies in Denmark: a prospective nationwide study. Lancet (London, England). 2001;358(9288):1124–8. doi: 10.1016/S0140-6736(01)06251-1 . [PMID: 11597665]
- Simons MP, Smietanski M, Bonjer HJ, Bittner R, Miserez M, Aufenacker TJ, et al. HerniaSurge Group, Simons MP, Smietanski M, Bonjer HJ, Bittner R, Miserez M, Aufenacker TJ, et al. International guidelines for groin hernia management. Hernia. 2018;22(1):1-165 doi: 10.1007/s10029-017-1668-x . [PMID: 29330835]
- Dai W, Chen Z, Zuo J, Tan J, Tan M, Yuan Y. Risk factors of postoperative complications after emergency repair of incarcerated groin hernia for adult patients: a retrospective cohort study. Hernia. 2019;23(2):267–76. doi: 10.1007/s10029-018-1854-5. [PMID: 30421299]
- Lebeau R, Traoré M, Anzoua KI, Kalou ILB, N’Dri AB, Aguia B, et al. Prognostic factors of postoperative morbidity and mortality of adult strangulated groin hernia. Indian J Surg. 2016;78(3):192–6. doi: 10.1007/s12262-015-1343-3 . [PMID: 27358513]
- Kadioglu H, Ömür D, Bozkurt S, Ferlengez E, Memm N, Ersoy YE, et al. Ischemia modified albumin can predict necrosis at incarcerated hernias. Dis Markers. 2013;35(6):807–10. doi: 10.1155/2013/185425 . [PMID: 24379518]
- Keeley JA, Kaji A, Kim DY, Putnam B, Neville A. Predictors of ischemic bowel in patients with incarcerated hernias. Hernia. 2019;23(2):277–80. doi: 10.1007/s10029-019-01884-1 . [PMID: 30689076]
- Köksal H, Ateş D, Nazik EE, Küçükosmanoğlu İ, Doğan SM, Doğru O. Predictive value of preoperative neutrophil-to-lymphocyte ratio while detecting bowel resection in hernia with intestinal incarceration. Ulus Travma Acil Cerrahi Derg. 2018;24(3):207–10. doi: 10.5505/tjtes.2017.93937 . [PMID: 29786814]
- Kahramanca S, Kaya O, Ozgehan G, Guzel H, Azili C, Gokce E, et al. Are fibrinogen and complete blood count parameters predictive in incarcerated abdominal hernia repair? Int Surg. 2014;99(6):723–8. doi: 10.9738/INTSURG-D-13-00107.1 . [PMID: 25437578]
- Xie X, Feng S, Tang Z, Chen L, Huang Y, Yang X. Neutrophil-to-lymphocyte ratio predicts the severity of incarcerated groin hernia. Med Sci Monit. 2017;23:5558–63. doi: 10.12659/msm.905728 . [PMID: 29166362]
- Icoz G, Makay O, Sozbilen M, Gurcu B, Caliskan C, Firat O, et al. Is D-dimer a predictor of strangulated intestinal hernia? World J Surg. 2006;30(12):2165–9. doi: 10.1007/s00268-006-0138-x . [PMID: 17103099]
- Markogiannakis H, Memos N, Messaris E, Dardamanis D, Larentzakis A, Papanikolaou D, et al. Predictive value of procalcitonin for bowel ischemia and necrosis in bowel obstruction. Surgery. 2011;149(3):394–403. doi: 10.1016/j.surg.2010.08.007 . [PMID: 20869092]
- Kulah B, Polat Duzgun A, Moran M, Kulacoglu IH, Mahir Ozmen M, Coskun MSF. Emergency hernia repairs in elderly patients. Am J Surg. 2001;182(5):455–9. doi: 10.1016/s0002-9610(01)00765-6 . [PMID: 11754850]
- Koizumi M, Sata N, Kaneda Y, Endo K, Sasanuma H, Sakuma Y, et al. Optimal timeline for emergency surgery in patients with strangulated groin hernias. Hernia. 2014;18(6):845–8. doi: 10.1007/s10029-014-1219-7 . [PMID: 24435318]
- Kurt N, Oncel M, Ozkan Z, Bingul S. Risk and outcome of bowel resection in patients with incarcerated groin hernias: retrospective study. World J Surg. 2003;27(6):741–3. doi: 10.1007/s00268-003-6826-x . [PMID: 12724826]
- Derici H, Unalp HR, Bozdag AD, Nazli O, Tansug T, Kamer E. Factors affecting morbidity and mortality in incarcerated abdominal wall hernias. Hernia. 2007;11(4):341–6. doi: 10.1007/s10029-007-0226-3 . [PMID: 17440794]