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

Abstract

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.

Short-Term Outcomes of Inguinal Hernia Repair in Older Patients: A Retrospective Review at a Tertiary Center

“…Older patients are unique in multiple ways, and therefore, physicians approach them differently [4]. IH is a common disease in older individuals, and its repair is associated with low morbidity and mortality rates; however, these patients are occasionally offered watchful waiting [1,4,[6][7][8]. Our study demonstrated that older patients undergoing IH repair have comparable results to those of younger patients with no significant perioperative risk or complications.…”

“…Having a higher BMI could explain this association; as in female patients, the rate of obesity (BMI ≥30) was 38% versus 24% in male patients. Köckerling et al [7] reported a similar correlation for older women who underwent emergency groin surgery. They found that patients who required bowel resection during emergency groin hernia repair and female patients who were ≥66 years had unfavorable perioperative outcomes [7].…”

“…Köckerling et al [7] reported a similar correlation for older women who underwent emergency groin surgery. They found that patients who required bowel resection during emergency groin hernia repair and female patients who were ≥66 years had unfavorable perioperative outcomes [7]. Another study by Nilsson et al [9] showed that female patients had a greater risk of postoperative mortality, which can be attributed to a higher rate of emergency procedures irrespective of the type of hernia.…”

“…Elective IH repair is considered a safe and low-risk surgery and has a valuable role in preventing hernia-related complications [1,3]. However, older patients are occasionally approached conservatively and denied surgery because of their functional status and the presence of comorbidities [1,4,[6][7][8].…”

“…Up to 8% of IH emergency surgery is indicated when incarceration, obstruction, or strangulation occurs as a result of a narrow hernia neck or adhesions between the hernia content and sac [7,9]. Most of those who have emergency surgery are older, and older patients have significantly higher morbidity and mortality rates than younger patients do [2,9].…”