Abstract
Purpose
Incarcerated femoral hernia patients had high risk of hernia contents necrosis. We provide our experience of management ischemia and necrosis of hernia contents in emergency incarcerated femoral hernia patients, and to investigate its risk factors.
Methods
This is a case–control study. Eighty-nine incarcerated femoral patients who underwent emergency surgery from January 2015 to December 2021 were included, and divided into normal group (60 cases) and ischemia/necrosis group (29 cases) according to the intraoperative condition of hernia contents. The surgical methods, intraoperative and postoperative conditions were compared between the two groups. Multivariate logistic regression was used to analyze the risk factors of ischemia and necrosis of hernia contents.
Results
Open preperitoneal tension-free repair was the most commonly used surgical methods (68.5%) for incarcerated femoral patients. The utilization rate of laparoscopic repair in the ischemia/necrosis group was lower than that in the normal group (13.8% vs. 20.0%, P = 0.475). The proportion of mesh placement in the normal group was significantly higher than that in the ischemia/necrosis group (98.3% vs 65.5%, P < 0.001). The hernia contents resection rate (55.2% vs 1.7%), operation time (90 vs 40 min), intraoperative bleeding (5 vs 2 ml), ICU admission rate (31.0% vs 1.7%), and hospital stay (7 vs 4 d) were significantly higher in the ischemia/necrosis group than those in normal group. Results of multivariate logistic regression showed that incarceration time more than 9 h (aOR = 19.3, 95%CI: 1.9–192.9) was an independent risk factor for ischemia and necrosis of hernia contents in emergency incarcerated femoral hernia patients.
Conclusion
Open tension-free repair was the most commonly used surgical methods for emergency incarcerated femoral hernia patients. Ischemia and necrosis of hernia contents will increase bowel resection rate and prolong operation and hospital stay. Long incarceration time is an independent risk factor for ischemia and necrosis of hernia contents.
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Data availability
The data associated with the paper are not publicly available but are available from the corresponding author on reasonable request.
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FW and QM designed the study, analyzed the data, interpreted the results, and drafted the manuscript. XL, CL, HY, JC searched the literature, collected the data and revised the manuscript. YS conceived the study, designed the study, supervised the study, interpreted the results, and revised the manuscript. All authors contributed to the manuscript and read and approved the final version of the manuscript.
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This study was approved by the Ethical Committee of Bei**g Chaoyang Hospital, Capital Medical University.
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All the procedures performed in this study were in accordance with the ethical standards of the Ethics Committee of Bei**g Chaoyang Hospital, Capital Medical University and with the 1964 Helsinki Declaration and its later amendments. This study does not contain any animals performed by the authors.
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Wang, F., Ma, Q., Liu, X. et al. Managing ischemic and necrotic incarcerated femoral hernia contents and their risk factors. Hernia (2024). https://doi.org/10.1007/s10029-024-03056-2
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DOI: https://doi.org/10.1007/s10029-024-03056-2