Emergency Femoral Hernia Repair

Dahlstrand, Ursula; Wollert, Staff An; Nordin, Pär; Sandblom, Gabriel; Gunnarsson, Ulf

doi:10.1097/sla.0b013e31819ed943

Cited by 181 publications

(104 citation statements)

References 19 publications

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“…Despite the fact that femoral hernias account for only 2-4% of all groin hernias, their timely and correct diagnosis is vital due to the increased mortality associated with emergency surgery for their complications (3). This, however, is not always easy.…”

Section: Discussionmentioning

confidence: 99%

Richter's type strangulated femoral hernia containing caecum and appendix masquerading as a groin abscess

Arkoulis

Savanis

Simatos

2012

Journal of Surgical Case Reports

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Femoral hernias are challenging conditions, not only because their diagnosis is often missed, but also because if left undiagnosed and untreated, their complications are severe and often life-threatening. The authors present the second reported case of a femoral hernia of the Richter’s variety containing caecum and appendix that, following strangulation and perforation, manifested as a groin abscess.

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Section: Discussionmentioning

confidence: 99%

Richter's type strangulated femoral hernia containing caecum and appendix masquerading as a groin abscess

Arkoulis

Savanis

Simatos

2012

Journal of Surgical Case Reports

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“…Gangrene was associated with an increased risk in mortality, consistent with other studies that have examined emergent general surgeries, 19 – 22 but obstruction was not associated with increased mortality within this inpatient population. Previous studies have shown that higher mortality from ED admissions is related to more clinically emergent presentations 1 , 23 . Our analysis adjusted for the presence of such hernia complications as obstruction and gangrene as potential confounders to allow comparison of patients with similar clinical severity between ED admission and elective repairs requiring postoperative inpatient care.…”

Section: Discussionmentioning

confidence: 99%

Emergency department utilization and predictors of mortality for inpatient inguinal hernia repairs

Mehta

Hutfless

Blair³

et al. 2017

Journal of Surgical Research

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Background: Although inguinal hernias are common surgical diagnoses, minimally symptomatic patients are often not scheduled for repairs and are asked to seek medical attention if they develop symptoms. We investigated factors associated with emergency department (ED) utilization for inguinal hernia repairs and determined whether ED utilization affected mortality for this otherwise electively treated condition. Methods: We performed a retrospective analysis of the 2009–2013 Nationwide Inpatient Sample to identify patients who presented through the ED and were then admitted for unilateral inguinal hernia repairs. Multivariable logistic regressions that adjusted for several patient and hospital characteristics determined predictors of both ED admission and postoperative mortality. Results: There were 116,357 inpatient hospitalizations. The majority (57%) resulted from ED admissions, of which most (85%) had a diagnosis of obstruction or gangrene. Notable predictors of ED admission from the multivariable analysis included obstruction (odds ratio, 9.77 [95% confidence interval: 9.05–10.55]), gangrene (18.24 [13.00–25.59]), Black race (1.47 [1.29–1.69]), Hispanic ethnicity (1.35 [1.18–1.54]), self-pay (2.29 [1.97–2.66]) and Medicaid insurance (1.76 [1.50–2.06]). While overall mortality decreased from 2.03% in 2009 to 1.36% in 2013, admission through the ED was independently associated with higher mortality compared with elective repair (1.67 [1.21–2.29]), even after adjusting for the diagnosis of obstruction and gangrene. Other predictors of mortality included patient age and comorbidities. Conclusions: In our study, Black, Hispanic, and self-pay patients were more likely to present through the ED. After adjusting for obstruction or gangrene, simply presenting through the ED was independently associated with a 67% higher postoperative mortality rate compared with that of an elective operation. Our findings suggest both a difference in ED utilization and subsequent difference in mortality by patient race and ethnicity and insurance for this common surgical condition.

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“…The reason for this is that in emergency cases often bowel or omentum is resected due to strangulation which is an environment which would increase the risk of mesh infection, if peritonitis or an abscess especially is apparent [2]. Mesh repair has been shown to have a reduced recurrence rate compared with primary suture repair in the elective setting with no significant differences found in the emergency setting [1, 5]. Increased recurrence has been found in femoral hernias compared to inguinal hernias and emergency compared to elective cases [1].…”

Section: Discussionmentioning

confidence: 99%

“…Mesh repair has been shown to have a reduced recurrence rate compared with primary suture repair in the elective setting with no significant differences found in the emergency setting [1, 5]. Increased recurrence has been found in femoral hernias compared to inguinal hernias and emergency compared to elective cases [1]. …”

Section: Discussionmentioning

confidence: 99%

“…They are the most likely to become strangulated due to the narrow femoral canal and rigid femoral ring. Strangulation may lead to bowel resection which has been shown to have increased mortality and morbidity [1]. The aetiology of femoral hernias is a controversial issue due to lack of evidence in terms of congenital versus acquired theory.…”

Section: Introductionmentioning

confidence: 99%

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Intestinal Obstruction due to Bilateral Strangulated Femoral Hernias

Nikolopoulos

Oderuth

Ntakomyti

et al. 2014

Case Reports in Surgery

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Introduction. Femoral hernias are at high risk of strangulation due to the narrow femoral canal and femoral ring. This can lead to symptoms of obstruction or strangulation requiring emergency surgery and possible bowel resection. To our knowledge, there is only one previous published report of bilateral strangulated femoral hernia. We present our case of this phenomenon. Case Report. An 86-year-old woman presented with symptoms of small bowel obstruction. Examination revealed two tender lumps in the area of the femoral triangle. CT scan revealed bilateral femoral hernias. Both hernias were repaired and a small bowel resection on the right side was performed with side to side anastomosis. She made an uneventful recovery. Conclusion. Bilateral femoral hernias are a rare occurrence with only one reported case of bilateral strangulation. Our case highlights the importance of meticulous history taking and clinical examination as any delay in diagnosis will increase the risk of mortality and morbidity for the patient. Hernias should always be considered as a cause if one presents with symptoms of abdominal pain or obstruction.

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Emergency Femoral Hernia Repair

Abstract: Femoral hernias are more common in women and lead to a substantial over risk for an emergency operation, and consequently, a higher rate of bowel resection and mortality. Femoral hernias should be operated with high priority to avoid incarceration and be repaired with a mesh.

Cited by 181 publications

References 19 publications

Richter's type strangulated femoral hernia containing caecum and appendix masquerading as a groin abscess

Richter's type strangulated femoral hernia containing caecum and appendix masquerading as a groin abscess

Emergency department utilization and predictors of mortality for inpatient inguinal hernia repairs

Intestinal Obstruction due to Bilateral Strangulated Femoral Hernias

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