Incidence and Outcomes of Emergency Presentation With Complicated Abdominal Wall Hernias: A Retrospective Study

Abstract

Aims This study aims to analyse the type of repair and post-op outcomes for individuals who underwent surgical intervention and presented with symptomatic abdominal wall hernia as an emergency. It highlights the importance of timely elective hernia management in lowering emergency presentations and any related complications. Background Abdominal wall hernias are common surgical conditions that can present electively or as emergencies, with emergency cases being associated with higher complication rates. In recent years, there has been an increase in emergency hernia presentations, leading to a greater number of urgent surgeries. These emergency operations have been linked to higher rates of post-op complications and re-interventions due to factors like bowel obstruction, strangulation, and delayed intervention. Therefore, research and analysis of post-op outcomes are essential to highlight the potential role of elective hernia management in reducing the burden of emergency cases. Methods This study was a single-institution retrospective study that looked at patient data over a 10-year period and involved patients who presented with abdominal wall hernias on an emergency basis and underwent surgical repair. Data were collected on patient demographics, presenting symptoms, hernia type, surgical technique, use of mesh reinforcement, post-op complications, re-intervention rates, and length of hospital stay. The database was developed and analysed with IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, NY, USA), and the results were considered significant at p<0.005. Results Over a 10-year period, 239 patients presented with emergency abdominal wall hernias, with 238 undergoing surgical repair; one patient died before surgery. Most repairs were performed using an open approach (93%, n=221), while 7% (n=17) were laparoscopic. Primary repair was conducted in 47% of cases (n=111), and mesh reinforcement was used in 53% (n=127). The overall recurrence rate was low (2%, n=4), with higher recurrence observed only in primary repairs. Mesh repairs had a higher incidence of post-op complications (56%, n=37) compared to primary repairs (44%, n=29). Patients who underwent mesh repair had an average hospital stay of eight days compared to those with primary repair (nine days). Inguinal, umbilical, and femoral hernias were the most common types observed, accounting for over 76% of cases. In total, 6% of patients (n=15) required bowel resections, highlighting the complexity of these cases. Most patients (72%, n=172) experienced no complications, but some of the most common post-op complications were wound dehiscence (7%, n=17), post-op collection (7%, n=16), delayed recovery (3%, n=8), and recurrence (2%, n=4). Conclusion It has been observed that a greater number of post-op complications and longer hospital stays are linked to emergency hernia procedures, especially when mesh repair is utilised. Although the recurrence rate of mesh repairs is lower than that of primary repair, the increased risk of complications highlights the significance of cautious surgical planning and patient selection. In conclusion, this study highlights the benefits of elective hernia management in reducing emergency presentations and the unfavourable consequences that may arise from it. These results support the importance of pre-op optimisation, especially for high-risk patients, and add to the debate on the best surgical techniques.

Keywords: femoral hernia; hernia; incarceration; inguinal hernia repair; laparoscopic vs open; post-op complications; strangulated inguinal hernia; strangulation; umbilical hernia; umbilical hernia repair.

Figure 1. Distribution of open vs. laparoscopic hernia repairs

Figure 2. Number of primary repair vs. mesh repair

Figure 3. Presenting complaints of patients

Figure 4. Number and type of post-op complications after emergency hernia surgery

SSI, surgical site infection; DVT, deep vein thrombosis

Figure 5. Number of additional surgical interventions