Prosthetic Mesh Repair in the Emergency Management of Acutely Strangulated Groin Hernias with Grade I Bowel Necrosis: A Rational Choice

Abstract

The aim of this study was to determine the feasibility of prosthetic mesh repair according to the degree of bowel necrosis in the emergency management of acutely strangulated groin hernias. Emergency prosthetic mesh repair versus primary suture repair was randomly performed in 208 consecutive strangulated groin hernia patients with bowel necrosis between January 2005 and August 2016. The degree of bowel necrosis of each patient was determined according to a modified three-grade classification system. Patient characteristics sorted by repair method were analyzed by using Pearson's chi-squared tests. Correlations between mortality and wound-related morbidity with bowel necrosis grade and repair method were analyzed. There was no difference in gender, age, body mass index, comorbid diseases, hernia type (left or right, primary or recurrent), necrosis grade, and mortality between the mesh repair and suture repair groups (all P > 0.05). However, with regard to wound-related morbidity, there was significant difference between the two groups ( P < 0.05). Mortality and wound-related morbidity showed significant relationship with necrosis grade, especially with regard to postoperative wound infection ( P < 0.001). The wound infection rate with mesh repair was significantly higher than that with primary suture in Grade II and III necrosis patients ( P < 0.05), but there was no difference in Grade I patients ( P > 0.05). The use of prosthetic mesh in the emergency repair of acutely strangulated groin hernias seems to be as safe as suture-only repair in patients with noninfected strangulated bowel (Grade I necrosis). The use of prosthetic mesh repair is a rational choice made based on the degree of bowel necrosis in the emergency management of acutely strangulated hernias.

The Use of Prosthetic Mesh in the Emergency Management of Acute Incarcerated Inguinal Hernias

“…This is especially important in patients with risk factors such as diabetes, chronic obstructive pulmonary disease, immunological disorders, and during glucocortico-steroid therapy. 4 Apart from strictly following the rules of aseptic and antiseptic behavior, systematic delivery antibiotic prophylaxis allowed a low wound infection rate. 32 Many surgeons prefer to use antibiotic to prevent infections.…”

“…3 With prolonged necrosis time, the surgical field presents with cellulitis and is clearly infected. 4 The emergency surgery is to repair the weak area of the abdominal wall using the most appropriate technique with the lowest possibility of recurrence. Tension-free hernia repair has been regarded as a gold standard treatment for selected inguinal hernias, but the use of prosthetic mesh in acute incarcerated inguinal hernias is controversial.…”

“…3 With prolonged necrosis time, the surgical field presents with cellulitis and is clearly infected. 4…”

Manual Reduction of Incarcerated Abdominal Wall Hernias. A Feasible Option during COVID-19 Pandemic: A Prospective Study

“… 3 Emergency hernia repair rates increase with age, especially in people over 50 years, occur more frequently in males, 4 and result in increased morbidity and mortality by 10 to 20 folds compared with elective surgery. 5 For this reason, elective surgery should be encouraged. In the emergency setting of an incarcerated hernia, the associated surgical morbidity or even mortality could be decreased if another modality could be used safely to reduce incarcerated hernias.…”