Outcomes of emergency and elective femoral hernia surgery in four district general hospitals: a 4-year study.
BACKGROUND
A large number of femoral herniae present as emergencies accounting for significant morbidity and mortality, which have remained unchanged over the last decade. Reports of outcomes in femoral hernia surgery are scarce, even more so in district general hospitals where a significant proportion of surgeries are performed. This study compares results of emergency and elective femoral hernia surgery in four district general hospitals against published rates up to a decade ago.


METHODS
A retrospective study of all patients undergoing femoral hernia surgery in four district hospitals between 2000 and 2004.


RESULTS
Seventy-three patients had 75 (28 emergency, 47 elective) femoral hernia repairs. Emergency presentations were associated with increased age(P = 0.001) and right-sided hernias (P = 0.024). Emergency surgery led to increased bowel resection (10.7 vs. 0%, P < 0.001) and longer hospital stays (8 vs. 1 day, P < 0.001) compared to elective surgery. There was no difference in complication rates between emergency and elective surgery (21.4 vs. 12.8%, P = 0.322) or opposition and pectineal flap repair (12.9 vs. 36.4%, P = 0.149). Overall recurrence, morbidity, and mortality were 4.2, 16 and 1.3%, respectively. One patient (3.6%) died after emergency surgery, and no deaths occurred with elective surgery.


CONCLUSIONS
The proportion of femoral herniae presenting as emergencies remained unchanged. This accounts for the morbidity and mortality in femoral surgery, which remains high and similar to a decade ago. Early diagnosis by clinicians and general practitioners and elective surgery are required to reduce mortality. Further investigation into the effect of the opposition technique on femoral vein compression and deep venous thrombosis is warranted.
Suppiah
A
A
Scarborough General Hospital, Woodlands Drive, Scarborough, Yorkshire YO12 6QL, UK. aravindsuppiah@hotmail.com
Gatt
M
M
Barandiaran
J
J
Heng
M S
MS
Perry
E P
EP
D000368:Aged; D000369:Aged, 80 and over; D017558:Elective Surgical Procedures / Q000379:methods*; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006550:Hernia, Femoral / Q000601:surgery*; D006767:Hospitals, District; D006769:Hospitals, General; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome