A new technique in the evaluation of strangulated and incarcerated hernias: Near infrared spectroscopy

Abstract

BACKGROUND: The present study aims to investigate the usefulness of NIRS in identifying decreased blood flow in intestinal tissue inside the hernial sac in incarcerated hernias. METHODS: Forty patients with manually irreducible inguinal hernias and with ileus determined by clinical findings and imaging were included in this study. Patients' intestinal oxygenatıons were measured by placing NIRS probes over the areas of inguinal hernia and over non-herniated areas immediately lateral to these. Differences in oxygenation between normal and herniated areas were evaluated. RESULTS: Forty patients, 14 women (35.0%) and 26 (65.0%) men, with a mean age of 65±14, were enrolled in this study. Intestinal oxygenation was lower in areas of irreducible hernia compared to normal regions (p<0.001). Incarceration and/or strangulation were detected when hernial sacs with low intestinal oxygenation were operated on. Low NIRS measurements were able to identify incarceration and/or strangulation in the intestine but were unable to distinguish between them. CONCLUSION: In conclusion, in the light of the findings of this study, although not capable of differentiating incarceration from strangulation, NIRS appears to be a good method for showing impaired intestinal oxygenation. NIRS can be used to support ultrasonography findings in irreducible hernias. Therefore, this technique could be used in the future to evaluate and monitor intestinal oxygenation in the Emergency Department.