A Novel Bowel Necrosis Classification System and Examination of Patient Outcomes in Incarcerated Groin Hernia Patients

Abstract

The objective of this study was to determine a classification system for BN in incarcerated groin hernia patients and to explore the possible relationship between BN staging and patient outcomes. Incarcerated groin hernia patients treated with emergency bowel resection from January 2008 to December 2013 were screened for inclusion in a prospective study. A novel three-stage classification system was proposed for BN (BN stages I–III) and correlations between adverse events (AEs) and mortality with BN stage were determined. A total of 108 patients were included, with 71, 26, and 11 patients in BN stages I, II, and III, respectively. AEs, which included wound and intra-abdominal infections and other systemic complications, increased with higher BN stage (all P < 0.05). Mortality increased with BN stage, with 2.8%, 7.7%, and 27.3% at BN stages I, II, and III, respectively (P < 0.05). The proposed BN staging system can objectively reflect the degree of bowel damage and its corresponding adverse outcomes.

Desarda’s repair versus Mesh hernioplasty for a strangulated inguinal hernia a randomized double-blind comparative study

“…All these patients required bowel resection with either anastomosis or stoma formation. The duration between the onset of the symptoms and presenting to the hospital was the important contributing factor, not only for the higher rates of advanced ischemia of bowel wall, but also influence the outcome in these patients, similar findings have been observed by other authors in their studies [23][24][25] . In the current study majority of the patients belongs to the villages, due to lack of adequate medical facilities, and by ignorance about the seriousness of the condition they were trying with local physicians and quacks to get relief from the symptoms, this appears to be the reason for their late presentation.…”

Hernioscopy in Incarcerated Inguinal Hernia Spontaneously Reduced after General Anesthesia Induction

“…This could happen spontaneously in the operating room during induction of anesthesia or when an initial groin incision is already performed, and it is important to evaluate abdominal contents to prevent a disaster. However, there are no guidelines on the most appropriate intervention in case of hernia reduction and possible bowel ischemia/necrosis [ 7 ]. When bowel ischemia is suspected, the intra-abdominal exploration is obligatory to definitively assess viability, and management depends on the surgeon’s preference to proceed with exploratory laparotomy or perform diagnostic laparoscopy.…”