Emergency presentation of abdominal hernias: outcome and reasons for delay in treatment - a prospective study.
BACKGROUND
Emergency hernia surgery is associated with a higher postoperative complication and a less favourable outcome. The aim of this study was to audit emergency presentations of abdominal hernias prospectively in order to identify delays in patient treatment.


METHODS
Prospective audit was carried out between January and September 2003 of all patients presenting acutely with symptomatic hernias. In total, 55 patients presented, 39 of whom needed surgical intervention. The emergency repairs were compared with a cohort of elective repairs performed in the trust at the same time.


RESULTS
The median age was 77 years (range, 5-92 years; 35 male, 20 female). The distribution of the hernias, requiring surgery, was inguinal (19), para-umbilical (10), incisional (5) and femoral (5). The overall complication rate was 46.2% and the in-patient stay was 4 days (range, 1-49 days). Six patients required small bowel resection. Conservative management was identified as a key contributing factor in the delay of treatment. There was a significant increase in the in-patient stay, the early complication rate and the small bowel resection rate in the emergency repairs.


CONCLUSIONS
Patients with a symptomatic hernia should be offered elective, surgical repair. Non-operative management is inappropriate for the vast majority of cases, especially when many repairs may be performed with local anaesthetic infiltration. Clinicians should be aware of the high morbidity associated with the emergency repair of abdominal hernias in the elderly.
Davies
Mark
M
Department of Surgery, Royal Gwent Hospital, Newport, Gwent, UK. markdavies999@hotmail.com
Davies
Chris
C
Morris-Stiff
Gareth
G
Shute
Ken
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D004638:Emergency Treatment / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D046449:Hernia, Abdominal / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome; D014218:Triage / Q000706:statistics & numerical data; D014852:Wales