Ultrasound may decrease the emergency surgery rate of incarcerated inguinal hernia.
OBJECTIVE
Manual reduction is the standard procedure for incarcerated inguinal hernia reduction. The role of ultrasound in incarcerated inguinal hernia reduction has not been defined. The aim of this study was to determine whether ultrasound can improve the ability to reduce incarcerated inguinal hernia safely when manual reduction fails and thereby decrease the emergency surgery rate.


METHODS
Between January 1994 and December 2003, 112 adult patients with incarcerated inguinal hernias were admitted to a university medical center and classified into two groups. Group I consisted of 61 patients who received emergency surgical reduction after the failure of two attempts at manual reduction. In Group II, comprising 51 patients, ultrasound-guided reduction was performed when two attempts at manual reduction failed. Emergency surgical reduction was scheduled if both ultrasound-guided reduction and two attempts at manual reduction failed. The difference in emergency surgery rates between groups I and II was compared.


RESULTS
In group I, manual reduction was successful in 55 cases (90.2%) and 6 patients underwent emergency surgery. In group II, manual reduction was successful in 45 cases, ultrasound-guided reduction in 4 cases, 1 reduction was avoided after ultrasonic examination, and 1 patient underwent emergency surgery. The emergency surgery rates in groups I and II were 9.8% and 2.0%, respectively.


CONCLUSIONS
Ultrasound can improve the ability to reduce incarcerated inguinal hernia safely when manual reduction fails and may decrease the rate of emergency surgery.
Chen
Shyr-Chyr
SC
Department of Emergency Medicine, National Taiwan University Hospital & National Taiwan University College of Medicine, Taipei, Taiwan. scc@ha.mc.ntu.edu.tw
Lee
Chien-Chang
CC
Liu
Yueh-Ping
YP
Yen
Zui-Shen
ZS
Wang
Hsiu-Po
HP
Huei-Ming Ma
Matthew
M
Fang
Cheng-Chung
CC
Chen
Wen-Jone
WJ
Lai
Hong-Shiee
HS
Lee
Po-Huang
PH
Lin
Fang-Yue
FY
Chen
Wei-Jao
WJ
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*