Manual Reduction of Incarcerated Abdominal Wall Hernias. A Feasible Option during COVID-19 Pandemic: A Prospective Study

Abstract

Background Incarcerated hernia is a common surgical emergency with considerable morbidity or even mortality. Manual reduction (taxis) and elective surgery could be an alternative management approach. This study examines the role of taxis with the adjuvant use of the visual analogue scale (VAS) score in treating incarcerated hernias and thereby decreasing the emergency surgery rate, especially during the novel coronavirus disease 2019 (COVID-19) pandemic. Methods All adult patients admitted to the emergency department of our hospital with incarcerated hernias of anterior abdominal wall were prospectively submitted to hernia manual reduction. The VAS score was used as an adjuvant tool for monitoring the success of this maneuver. Patients with successful taxis and low VAS score were hospitalized for a 24-hour period of observation. On their discharge, they were scheduled for an elective hernia repair. Patients with unsuccessful taxis or with less than a 50% reduction in VAS score after successful taxis were submitted to emergency surgical repair. Age, sex, type of hernias, time until taxis, VAS scores before and after taxis, length of hospital stay, and adverse events for both groups were recorded. Results Between September 2018 and September 2020, 86 patients with incarcerated hernias were included. The types of hernias were incisional in 8 patients, umbilical in 15 patients, inguinal in 56 patients, and femoral in 7 patients. Taxis was successful in 66% of patients with a mean reduction in VAS score from 83 to 17 mm. Following successful taxis, patients were hospitalized for a 24-hour period of observation. No taxis-related complications were observed. Fifty-two patients were safely discharged from hospital and scheduled for an elective repair during the first month. Thirty-four patients were operated emergently. Five patients had successful taxis but with a reduction of posttaxis VAS score less than 50% (a mean reduction from 86 to 62 mm), while taxis failed in twenty-nine patients. Patients with emergency surgery had longer time until reduction and longer stay of hospitalization. In this group, two patients required admission to the intensive care unit while one patient died. Conclusion In this protocolized approach, taxis is a safe and feasible option for most patients with incarcerated hernias. It should be kept in our armament, especially in times when emergency surgery capabilities are under strain like the ongoing COVID-19 pandemic.

Emergency umbilical hernia management: scoping review

“…Four studies described the impact of the timing of emergency umbilical hernia repair 2 , 7 , 14 , 16 . Two were retrospective cohort studies from national databases 2 , 14 and two were small single-centre studies 7 , 16 .…”

“…Four studies described the impact of the timing of emergency umbilical hernia repair 2 , 7 , 14 , 16 . Two were retrospective cohort studies from national databases 2 , 14 and two were small single-centre studies 7 , 16 . A study of the NSQIP database found that, despite overall increased odds of a major complication with next-day surgery for all emergency hernia presentations, multivariable logistic regression for next-day umbilical hernia surgery was associated with decreased odds of a major complication compared to surgery delayed more than one day 2 .…”

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

“…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. In the present study, we roughly estimated that, for inguinal hernioplasties carried out in this hospital, the total net national tablebased reimbursement, during the pre-pandemic, amounted to 146,432 Euros for day surgeries, to 60,211 Euros for outpatients and 143,483 Euros for inpatients, meanwhile during the pandemic amounted to 81,920 Euros for day surgeries, to 20,070 Euros for outpatients, and 216,974 Euros for inpatients, respectively: in particular, we inferred that the higher costs incurred for the inpatients during the pandemic are due to an increased number of urgent surgeries including, in most of the cases, complications of delayed elective surgeries.…”

“…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 …”

Impacts of COVID-19 on Patients With Common Surgical Emergencies at the King Fahad Specialist Hospital in Buraidah, Saudi Arabia

“…The significant delay between the patient's arrival and clinical presentation of symptoms has also been reported in another emergency department due to the fear of developing hospital-acquired infection and the lack of medical supplies [ 21 , 22 ]. It has been estimated this delay could lead to more severe outcomes, such as the development of gallbladder spillage or rupture [ 23 - 25 ].…”