Emergency hernia repairs in elderly patients

Külah, Bahadır; Düzgün, Arife Polat; Moran, Münevver; Kulacoglu, I.Hakan; Ozmen, MM; Coşkun, Murat

doi:10.1016/s0002-9610(01)00765-6

Cited by 129 publications

(94 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The observed deaths after emergency groin hernia repair transcends the expected deaths signiWcantly when the age of the patient is above 49 years, when the patient has an ASA class above 2, in the case of a femoral hernia, and when bowel resection was required during surgery. These result are conWrmed by other studies [14,35,37,39,40]. Table 3 shows that 14% of all emergency hernias contain necrotic bowel, necessitating bowel resection.…”

Section: Risk Of Incarceration and Strangulationsupporting

confidence: 78%

See 1 more Smart Citation

Is surgical repair of an asymptomatic groin hernia appropriate? A review

Heuvel

Dwars

Klassen

et al. 2011

Hernia

View full text Add to dashboard Cite

Purpose Groin herniorrhaphy is the most common operation performed by general surgeons. Annually, more than 20 million groin hernias are repaired worldwide. The general approach towards groin hernias is surgical repair regardless of the presence of symptoms. The rationale to recommend surgery for asymptomatic groin hernias is prevention of visceral strangulation. The goal of this review is to evaluate the appropriateness of surgery in patients with asymptomatic groin hernias. Methods The review was based on an extensive literature search of Pubmed, Medline and the Cochrane Library. Results The risk of incarceration is approximately 4 per 1,000 patients with a groin hernia per year. Risk factors for incarceration are age above 60 years, femoral hernia site and duration of signs less than 3 months. Morbidity and mortality rates of emergency groin hernia repair are higher in patients who are older than 49 years, have a delay between onset of symptoms and surgery of more than 12 h, have a femoral hernia, have nonviable bowel and have an ASA-class of 3 or 4. The recurrence rate after tension-free mesh repair in the management of emergency groin hernias is comparable to that of elective repair. There is no diVerence in pain and quality of life after elective repair compared to watchful waiting. There is no advantage in cost-eVectiveness of elective repair compared to watchful waiting. ConclusionWatchful waiting for asymptomatic groin hernias is a safe and cost-eVective modality in patients who are under 50 years old, have an ASA class of 1 or 2, an inguinal hernia, and a duration of signs of more than 3 months.

show abstract

Section: Risk Of Incarceration and Strangulationsupporting

confidence: 78%

“…Morbidity and mortality of emergency groin hernia repair Emergency groin hernia repair is associated with higher morbidity and mortality rates than elective groin hernia repair [8,11,13,34,37,38]. An overview of these rates reported in the literature is summarized in Table 3.…”

Section: Risk Of Incarceration and Strangulationmentioning

confidence: 99%

Is surgical repair of an asymptomatic groin hernia appropriate? A review

Heuvel

Dwars

Klassen

et al. 2011

Hernia

View full text Add to dashboard Cite

show abstract

“…[2,3] In such surgical operations, inadequate preoperative preparation and the advanced age of the majority of the patients lead to a remarkable increase in morbidity and mortality. [4] The aim of the present study was to evaluate the rate of morbidity-and mortality-related risk factors in patients undergoing surgical operation in our emergency surgery clinic due to incarcerated AWH.…”

Section: Resultsmentioning

confidence: 99%

Incarcerated abdominal wall hernia surgery: relationship between risk factors and morbidity and mortality rates (a single center emergency surgery experience)

Özkan¹,

Yıldız²,

Çakır³

et al. 2012

Ulus Travma Acil Cerrahi Derg

View full text Add to dashboard Cite

AMAÇBu çalışmada, acil cerrahi kliniğimizde boğulmuş abdominal duvar hernisi nedeniyle ameliyat edilen hastalarda morbidite ve mortaliteyle ilişkili risk faktörlerinin insidansı araştırıldı. GEREÇ VE YÖNTEMHastalar hem fıtık türüne göre (inguinal, umblikal, insizyonel, femoral) kendi aralarında hem de morbidite ve mortalite üzerine etkili faktörler bakımından; yaş, cinsiyet, Amerikan Anesteziyoloji Derneği (AAD) skoru, anestezi tipi, eşlik eden hastalıklar, intestinal boğulma ve nekroz varlığı gibi verilerle değerlendirildi. BULGULARİnguinal herni erkeklerde, umblikal ve femoral herni kadınlarda sıktı (p<0,001). Femoral hernide boğulma ve nekrozdan dolayı intestinal rezeksiyon diğer fıtık türleri-ne göre anlamlı olarak yüksek saptandı (sırasıyla, p<0,005 ve p<0,001). Morbidite ve mortalite üzerine; ileri yaş (≥65 yaş), ek hastalık, strangülasyon, nekroz, yüksek AAD skoru (III, IV), semptomların başlama ve hastaneye başvuru süresinin anlamlı etkisi bulundu. Genel anestezinin de morbidite için risk oluşturduğu görüldü (p<0,05). SONUÇBoğulmuş abdominal duvar hernileri yüksek morbidite ve mortalite oranına sahip bir cerrahi problemdir. Bu yüzden herni saptandığında elektif koşullarda ameliyat planlanmalıdır.Anahtar Sözcükler: Abdominal duvar hernisi; inkarserasyon; nekroz; strangülasyon. BACKGROUNDThe aim of the present study was to investigate morbidityand mortality-related risk factors in patients undergoing surgery due to incarcerated abdominal wall hernia. METHODSThe patients were grouped according to the type of hernia (inguinal, umbilical, incisional, femoral), and these groups were evaluated in terms of risk factors affecting morbidity and mortality such as age, gender, American Society of Anesthesiologists (ASA) score, type of anesthesia, concomitant diseases, and the presences of intestinal strangulation and necrosis. RESULTSInguinal hernia was frequent in males, whereas femoral hernia was frequent in females (p<0.001). The rate of intestinal resection due to strangulation and necrosis was found significantly higher among femoral hernias as compared to the other types of hernia (p<0.005 and p<0.001, respectively). Advanced age (≥65 years), concomitant disease, strangulation, necrosis, high ASA score (III-IV), time from the onset of symptoms, and time to hospital admission were found to have significant influences on morbidity and mortality. General anesthesia was found to be a risk factor for morbidity as well (p<0.05). CONCLUSIONIncarcerated abdominal wall hernias are surgical problems with high morbidity and mortality rates. Therefore, surgery should be planned under elective conditions when hernia is detected.

show abstract

“…Elderly patients had in increased incidence of necrotic bowel resection when compared with adults for the same duration of irreducibility. 7,8 This could not be explained by increased vulnerability of entrapped bowel to incarceration and ischemia in advanced ages. The basis keystone for successful outcome in the management of gangrenous bowel is early surgical intervention with liberal and antibiotic administration.…”

Section: Discussionmentioning

confidence: 96%

“…3 The mean age of patients with complications is 55years, compared to 65 years in other study by Pollok and 70 years by Andrew and Kulah et a1. [6][7][8] Takuev and colleagues found age as a significant factors for morbidity after operation for incarcerated hernias. 9 Elderly patients usually have complicated presentations and bowel obstruction and are consistent with the published observation of Oishi, Desunkamni, Andrew, Pollock, Dennis.…”

Section: Discussionmentioning

confidence: 99%

Clinical study on complicated presentations of groin hernias

Teerthanath

2017

Int J Res Med Sci

View full text Add to dashboard Cite

Background: Groin hernia is a very common type abdominal wall hernia encountered in surgical practice. Irreducibility, obstruction and strangulation are its commonest complications which usually presents as acute emergencies. Emergency repair of complicated hernias is associated with poor prognosis and a high rate of postoperative complications even with better care, improved anaesthetic management and advanced surgical techniques. The aim of this study was to determine the various modes of presentation, clinical finding, diagnostic and therapeutic strategies and to evaluate the postoperative outcome in complicated groin hernia surgeries in our set up. Methods: The study was carried out among 40 patients of groin hernia, who had complicated clinical presentation like irreducibility, strangulation and obstruction in the department of general surgery, during the period from March 2012 to June 2014. Patients were enrolled into the study after proper consent for detailed clinical examination, investigation and subsequent treatment. The Data obtained included demographic characteristics, presentation, operative findings and outcome. The patients were followed up for immediate and late complications for once a week for 1 months, once every month for the next 6 months. After data collection, analysis was done with help of by SPSS software version 21. Results: A total of 40 groin hernia patients with complicated presentation were evaluated during the study period. Among these cases 38 cases had inguinal hernias and two cases had femoral hernia. Majority of the patients were in 5th and 6th decade. Complicated presentation of groin hernia was commonly seen in males (95%) than in females (5%) with male to female ratio of 19:1. Inguinal hernia complications were seen predominantly in males and femoral hernia complications in females. Right sided hernias were more common. Incarceration was the commonest complication seen in 70% of case followed by strangulation (30%). Incarceration was high (17.5%) in the age group of 64-73 years and 44 -53 years. Strangulation was high in the age group of 54-63 years. The duration of hernia varied for 1-2 years in 42.5% of cases and 3-6 years in 27.5% of cases. Majority of the patients (30%) presented with localized groin pain, vomiting, constipation and abdominal distension. All patients presented with swelling in the inguinoscrotal region, which was tender, and there was no impulse on coughing and 35% of patients had cardiorespiratory illness. Majority of the cases (34 numbers) were operated as emergency procedure. Viable bowel was seen in 77.5% of cases. Bowel resection and end-to-end anastomosis was done in all cases of non-viable bowel and orchidectomy in atrophied and gangrenous testis. The commonest postoperative complication encountered in the study was wound infection (22.5%) and scrotal seroma (17.50%). There was no evidence of recurrence in any of the operated cases. Conclusions: Complicated presentations of groin hernias like, incarceration and strangulation are seen in ...

show abstract

Emergency hernia repairs in elderly patients

Cited by 129 publications

References 9 publications

Is surgical repair of an asymptomatic groin hernia appropriate? A review

Is surgical repair of an asymptomatic groin hernia appropriate? A review

Incarcerated abdominal wall hernia surgery: relationship between risk factors and morbidity and mortality rates (a single center emergency surgery experience)

Clinical study on complicated presentations of groin hernias

Contact Info

Product

Resources

About