Early outcomes of emergency ventral hernia repair in a cohort of poorly optimized patients

Abstract

BackgroundStrangulated and obstructed ventral hernias require emergent repair to mitigate the risk of life‐threatening complications. Emergency ventral hernia repairs are associated with a higher rate of surgical complications and recurrence compared to elective repairs. The purpose of this study was to explore the impact of patient factors, hernia and operative characteristics on post‐operative outcomes in patients requiring emergency ventral hernia repairs.MethodsData were collected from a prospectively held database on 86 consecutive patients undergoing emergency ventral hernia repairs between January 2016 and January 2019 at Logan Hospital. Patient, hernia and operative characteristics were collected for reporting and analysis.ResultsOf the 86 patients, 29 (34%) developed a surgical complication, of which 17 patients (59%) had surgical site infections. We identified obesity (P = 0.017), history of smoking (P = 0.008), American Society of Anesthesiologists class of III–IV (P = 0.008), hernia defect size ≥3 cm (P = 0.048) and concomitant small bowel resection (P = 0.028) to be associated with post‐operative surgical complication. Multivariate analysis identified smoking (P = 0.005) and concomitant small bowel resection (P = 0.026) as independent predictors for developing surgical complications. Seven patients (8%) recurred at a median of 221 days. Incisional hernias (P = 0.001), recurrent hernias (P < 0.001), greater than one defect (P < 0.001) and bowel involvement (P = 0.049) were associated with higher rates of hernia recurrence.ConclusionPatient factors significantly influence outcomes in the emergency setting. Given that this is not modifiable at the time of surgery, greater emphasis needs to be placed on optimizing the physical and behavioural factors of patients with early symptomatic hernias for an elective repair.

Predictors of early adverse postoperative outcomes following emergency groin hernia surgery: a prospective multicenter cohort

“…At multivariate analysis, a patient who had gut resection was 10.250 times more likely to have adverse outcomes compared to one that had no gut resection. Our ndings were in agreement with what was reported by Dissanayake (19) in Australia, where the need for bowel resection was associated with the occurrence of postoperative complications following emergency hernia surgery. Also in agreement with a study done in Egypt, which revealed that diabetes mellitus and bowel resection were signi cantly associated with adverse outcomes (25).…”

“…Also, in a study conducted at Mulago national referral hospital in Uganda, among patients with femoral hernias, wound complications were seen in 30.8% of the participants and respiratory complications in 7.7% (18). Dissanayake (19) reported that complications were seen in 34% of the study participants in Australia with surgical site infection being the commonest while Mabula & Chalya (20) observed that the overall complication rate was 34.6% with surgical site infection being the commonest in Tanzania (20). All the above had ndings comparable to our study ndings.…”

Outcomes After Spigelian Hernia Repair: A Nationwide Database Study

“…Studies examining these types of ventral hernia repairs (umbilical/epigastric), have shown significantly higher mortality, reoperation, and readmission rates in the emergency setting, compared to elective hernia repair [15,17,18]. However, this study showed no significant differences in readmission or reoperation rates in patients undergoing emergency hernia repair, compared to elective.…”

Morbidity and Mortality of Emergency Hernia Surgery in Adults in Bujumbura: Analysis of Favourable Factors

“…Inguinal hernia was the second most common type of hernia [13]. Other types of hernia are extremely rare in emergencies [14]. Only one case of Spigel's semi-lunar line hernia has been reported by the same authors [13].…”

“…Abdominal parietal hernia, the temporary or permanent exit of viscera through an anatomically pre-existing zone of weakness, is a frequent pathology in surgery [1]. It ranks second before vesicular lithiasis and after appendectomies in order of frequency [2]. Worldwide, the prevalence of strangulated hernias is estimated at 0.3% -2.9% [3].…”