Algorithm for management of an incarcerated inguinal hernia in the emergency settings with manual reduction. Taxis, the technique and its safety

Abstract

Background An acute inguinal hernia remains a common emergency surgical condition worldwide. While emergency surgery has a major role to play in treatment of acute hernias, not all patients are fit for emergency surgery, nor are facilities for such surgery always available. Taxis is the manual reduction of incarcerated tissues from the hernia sack to its natural compartment, and can help delay the need for surgery from days to months. The aim of this study was to prepare a safe algorithm for performing manual reduction of incarcerated inguinal hernias in adults. Methods Medline, Scopus, Ovid and Embase were searched for papers related to emergency inguinal hernias and manual reduction. In addition, the British National Formulary and Safe Sedation Practice for Healthcare Procedures: Standards and Guidance were reviewed. Results A safe technique of manual reduction of an acute inguinal hernia, called GPS (Gentle, Prepared and Safe) Taxis, is described. It should be performed within 24 h from the onset of a painful irreducible lump in groin, and when concomitant symptoms and signs of bowel strangulation are absent. Conscious sedation guidelines should be followed. The most popular drug combination is of intravenous morphine and short-acting benzodiazepine, both titrated carefully for optimal and safe effect. The dose of drugs must be individualised, and the smallest effective dosage should be used to avoid oversedation. Following successful taxis, the patient should undergo a short period of observation. Urgent surgery can be undertaken during the same admission or up to several weeks later. Conclusions Taxis is a benign/non-invasive method for patients with an acute, non-strangulated inguinal hernias. It likely reduces the risk and complications of anaesthesia and surgery in the emergency settings. GPS Taxis should be considered as first line treatment in the majority of patients presenting with an acute inguinal hernia when existing bowel infarction is unlikely.

Delta nötrofil indeksi, inkarsere inguinal fıtıklarda barsak rezeksiyonu gereğini öngörmede bir belirteç olarak kullanılabilir mi?

“…Urgent surgical intervention is needed in 5-15% of all patients diagnosed with inguinal hernia due to incarceration 4,5 is rate can go up to 38% in femoral hernia patients 6 . However, elective surgery is possible without emergency surgery when the incarcerated bowel segment can be reduced into the abdomen before ischemia develops or in cases where only the omentum is incarcerated 7 . e morbidity and mortality of elective hernia surgery are much lower when compared to emergency surgery in patients with comorbidities [7][8][9] .…”

“…However, elective surgery is possible without emergency surgery when the incarcerated bowel segment can be reduced into the abdomen before ischemia develops or in cases where only the omentum is incarcerated 7 . e morbidity and mortality of elective hernia surgery are much lower when compared to emergency surgery in patients with comorbidities [7][8][9] .…”

“…In addition to physical examination ndings and imaging methods, blood parameters (increase in white blood cell (WBC), serum D-Dimer >300 ng/ml, serum phosphokinase value >140 IU/U, elevated serum lactate, amylase, and C-reactive protein (CRP) levels) and other markers of the increased systemic in ammatory response may suggest the presence of intestinal ischemia. 7,11,15,16 .…”

The unexpected social cost of inguinal hernioplasty procedures derived from the COVID‐19 pandemic: Surgical trend analysis based on an Italian hospital series

“…12 Furthermore, it was suggested that the only chance to correctly diagnose a hernia with strangulation rather than incarceration is to perform a CT scan, but likely this strategy would not be economically feasible. 13 It was reported, at last, that the VAS score could add important findings to evaluate the persistence of pain even after a positive Taxis maneuver. 14 In view of the reimbursement provided to our hospital by the Italian National Health Service, in reference to inguinal hernioplasties, it has been used a standardized table costs format which unfortunately appeared to be poorly correlated with the overall unpredictability and also with the rising costs during the pandemic, especially when surgical interventions in urgent settings were performed.…”

Nomogram for the Estimation of Intestinal Necrosis Risk in Incarcerated Inguinal Hernia in Infants under 6 Months

“…8 GPS (Gentle, Prepared and Safe) Taxis is a safe technique for manually reducing an acute inguinal hernia. 9 Especially during the coronavirus disease 2019 pandemic, reducing emergency surgery is very beneficial. Therefore, when such a patient comes to the emergency department, the first step is to assess the blood supply of the hernia contents to decide whether to perform a manual reduction or an emergency surgery, so it is necessary to construct a model to predict intestinal necrosis.…”