Surgery for incarcerated hernia: short-term outcome with or without mesh.
BACKGROUND
Incarcerated hernias represent about 5-15 % of all operated hernias. Tension-free mesh is the preferred technique for elective surgery due to low recurrence rates. There is however currently no consensus on the use of mesh for the treatment of incarcerated hernias, especially in case of bowel resection.


OBJECTIVE
The aims of this study were (i) to report our current practice for the treatment of incarcerated hernias, (ii) to identify risk factors for postoperative complications, and (iii) to assess the safety of mesh placement in potentially infected surgical fields.


METHODS
This retrospective study included 166 consecutive patients who underwent emergency surgery for incarcerated hernia between January 2007 and January 2012 in two university hospitals. Demographics, surgical details, and short-term outcome were collected. Univariate analysis was employed to identify risk factors for overall, infectious, and major complications.


RESULTS
Eighty-four patients (50.6 %) presented inguinal hernias, 43 femoral (25.9 %), 37 umbilical hernias (22.3 %), and 2 mixed hernias (1.2 %), respectively. Mesh was placed in 64 patients (38.5 %), including 5 patients with concomitant bowel resection. Overall morbidity occurred in 56 patients (32.7 %), and 8 patients (4.8 %) developed surgical site infections (SSI). Univariate risk factors for overall complications were ASA grade 3/4 (P = 0.03), diabetes (P = 0.05), cardiopathy (P = 0.001), aspirin use (P = 0.023), and bowel resection (P = 0.001) which was also the only identified risk factor for SSI (P = 0.03). In multivariate analysis, only bowel incarceration was associated with a higher rate of major morbidity (OR = 14.04; P = 0.01).


CONCLUSIONS
Morbidity after surgery for incarcerated hernia remains high and depends on comorbidities and surgical presentation. The use of mesh could become current practice even in case of bowel resection.
Visceral and Endocrine Surgery Department, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France, auvenara@yahoo.fr.
A
A
Venara
M
M
Hubner
P
P
Le Naoures
J F
JF
Hamel
A
A
Hamy
N
N
Demartines
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D046449:Hernia, Abdominal / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D006550:Hernia, Femoral / Q000473:pathology / Q000601:surgery; D006552:Hernia, Inguinal / Q000473:pathology / Q000601:surgery; D006554:Hernia, Umbilical / Q000473:pathology / Q000601:surgery; D059685:Herniorrhaphy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013526:Surgical Mesh; D013530:Surgical Wound Infection / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult