Risk factors for bowel resection among patients with incarcerated groin hernias: A meta-analysis

Chen, Peng; Huang, Libin; Yang, Wenming; He, Diao; Liu, Xueting; Wang, Yong; Yu, Yanyan; Yang, Lie; Zhou, Zong-Guang

doi:10.1016/j.ajem.2019.09.023

Cited by 26 publications

(27 citation statements)

References 26 publications

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“…In addition to the subgroups of emergency groin hernia repair, perioperative complications are highly significantly negatively influenced by female gender and age ≥66 years (30).…”

Section: Discussionmentioning

confidence: 99%

Trends in Emergent Groin Hernia Repair—An Analysis From the Herniamed Registry

Köckerling

Heine²,

Adolf

et al. 2021

Front. Surg.

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Introduction: While the proportion of emergency groin hernia repairs in developed countries is 2.5–7.7%, the percentage in developing countries can be as high as 76.9%. The mortality rate for emergency groin hernia repair in developed countries is 1.7–7.0% and can rise to 6–25% if bowel resection is needed. In this present analysis of data from the Herniamed Registry, patients with emergency admission and operation within 24 h are analyzed.Methods: Between 2010 and 2019 a total of 13,028 patients with emergency admission and groin hernia repairs within 24 h were enrolled in the Herniamed Registry. The outcome results were assigned to the year of repair and summarized as curves. The total patient collective is broken down into the subgroups with pre-operative manual reduction (taxis) of the hernia content, operative reduction of the hernia content without bowel resection and with bowel resection. The explorative Fisher's exact test was used for statistical assessment of significant differences with Bonferroni adjustment for multiple testing.Results: The proportion of emergency admissions with groin hernia repair within 24 h was 2.7%. The percentage of women across the years was consistently 33%. The part of femoral hernias was 16%. The proportion of patients with pre-operative reduction (taxis) remained unchanged at around 21% and the share needing bowel resection was around 10%. The proportion of TAPP repairs rose from 21.9% in 2013 to 38.0% in 2019 (p < 0.001). Between the three groups with pre-operative taxis, without bowel resection and with bowel resection, highly significant differences were identified between the patients with regard to the rates of post-operative complications (4% vs. 6.5% vs. 22.7%; p < 0.0001), complication-related reoperations (1.9% vs. 3.8% vs. 17.7%; p < 0.0001), and mortality rate (0.3% vs. 0.9% vs. 7.5%; p < 0.001). In addition to emergency groin hernia repair subgroups female gender and age ≥66 years are unfavorable influencing factors for perioperative outcomes.Conclusion: For patients with emergency groin hernia repair the need for surgical reduction or bowel resection, female gender and age ≥66 years have a highly significantly unfavorable influence on the perioperative outcomes.

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“…In addition to the subgroups of emergency groin hernia repair, perioperative complications are highly significantly negatively influenced by female gender and age ≥66 years (30).…”

Section: Discussionmentioning

confidence: 99%

Trends in Emergent Groin Hernia Repair—An Analysis From the Herniamed Registry

Köckerling

Heine²,

Adolf

et al. 2021

Front. Surg.

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“…Apart from this, there are studies showing that there is an increased risk of small bowel resection in patients who are of female gender, [14][15][16] are of advanced age (>65), [14,17] have a long duration of incarceration, [15,[18][19][20] presence of bowel obstruction, [15,18,19] and an apparent peritonitis tableux. [15] Unlike in the studies mentioned above, in this study, it was observed that female gender and older age do not increase the risk of bowel resection.…”

Section: Discussionmentioning

confidence: 99%

“…When we looked at from the perspective of laboratory diagnostic methods, there are studies that assert that increased WBC count, [15,[18][19][20] increased neutrophil count [15,20] and increased NLR ratio, [18] increase the risk of small bowel resection. In all of these studies, comparisons were made according to whether there was a small bowel resection or not.…”

Section: Discussionmentioning

confidence: 99%

The Role Of The Lactate Level In Determining The Risk Rates Of Small Bowel Resection In Incarcerated Hernias

Şahin¹,

Buluş²,

Yavuz³

et al. 2020

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: An incarcerated hernia is a part of the intestine or abdominal tissue that becomes trapped in the sac of a hernia. An increase in morbidity and mortality occurs after intestinal resections from strangulated hernias. This study aims to examine the markers that may be effective in determining the risk of small bowel resection due to incarcerated hernias. In particular, we aimed to investigate the effect s of blood lactate levels in determining this risk. METHODS:A cross-sectional retrospective study was designed. Patients, whose preoperative diagnosis were reported as incarcerated hernia and had essential information, were included in this study. They were divided into two groups according to whether they had resection or not. Age, gender, hernia type, hernia side, resection material, blood lactate level (BLL), white blood cell (WBC), neutrophil count (NE), lymphocyte count (LY), neutrophil/lymphocyte ratio (NLR), platelet count (PLT), lactate dehydrogenase (LDH), radiologic bowel obstruction sign and comorbidities were evaluated. RESULTS:Sixty-seven patients were included in this study. It was observed that 16 (23.9%) of these patients underwent small intestinal resection, 16 (23.9%) had an omentum resection, while no resection was performed on 35 (52.2%) patients. There was a statistically significant difference regarding radiologically intestinal obstruction (p=0.001), hernia type (p=0.005), BLL (p<0.001), WBC, NLR and LDH values (p<0.05). In incarcerated hernia patients with a lactate value ≥1.46 mg/dL, sensitivity was observed to be 84.0% and specificity 86.0% (p<0.001). CONCLUSION:In patients with a preliminary diagnosis of an incarcerated hernia, the risk of possible small bowel resection is the most important point in deciding for an operation. The presence of an intestinal obstruction in radiological examinations, and particularly the high levels of WBC, NLR, LDH and BLL, may indicate a necessity for possible small bowel resection. Concerning the risk associated with small bowel resection, blood lactate levels ≥1.46 mg/dL may be alerting.

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“…Chen et al [13] reported in a meta-analysis that the total rate of resection was 21.0% (160/762) in the patients with incarcerated groin hernia. Eight factors were signi cantly related to the risk of bowel resection in their pooled analysis: female sex, femoral hernia, bowel obstruction duration of incarceration (hours), WBC count and neutrophilic leukocyte count.…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors of Bowel Resection Due to an Incarcerated Groin Hernia

Udaka¹,

Taniguchi²,

J³

et al. 2020

JJGH

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In this retrospective study, we assessed factors that can be used to predict the need for bowel resection due to an incarcerated groin hernia. MethodsWe enrolled a total of 83 patients diagnosed with an incarcerated groin hernia on preoperative unenhanced computed tomography (CT) between January 2010 and December 2019 in our hospital.They were divided into two groups: those who underwent bowel resection and those who did not. The clinical ndings, blood test results, and unenhanced CT values of patients were examined and compared between the two groups. The indication of intestinal resection was macroscopic necrosis or perforation of the incarcerated intestine. ResultsA total of 83 patients with incarcerated groin hernias were included in our study, of whom 13 (15.7%) had undergone bowel resection surgery. A univariate analysis identi ed a prolonged time from the symptom onset to surgery, increased white blood cell (WBC) count, increased C-reactive protein (CRP) level, decreased albumin level, and CT attenuation of the incarcerated intestinal wall at the fundus as signi cant predictive factors. The cut-off value for prediction of intestinal resection was 25 HU for the average CT attenuation of the incarcerated intestinal wall at the fundus and a WBC of 11,550 based on the receiver operating characteristic (ROC) curve. A multivariate analysis showed CT attenuation of the incarcerated intestinal wall at the fundus and an increased WBC count to be independent predictive factors. ConclusionsMeasuring unenhanced CT attenuation of the incarcerated intestinal wall at the fundus and the WBC count was suggested to be necessary for determining whether or not resection of the incarcerated intestine is required in cases of groin hernia.

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Risk factors for bowel resection among patients with incarcerated groin hernias: A meta-analysis

Cited by 26 publications

References 26 publications

Trends in Emergent Groin Hernia Repair—An Analysis From the Herniamed Registry

Trends in Emergent Groin Hernia Repair—An Analysis From the Herniamed Registry

The Role Of The Lactate Level In Determining The Risk Rates Of Small Bowel Resection In Incarcerated Hernias

Predictive Factors of Bowel Resection Due to an Incarcerated Groin Hernia

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