Analysis of diagnosis and treatment of internal hernia and its correlation with past abdominal surgery

Abstract

Objective To increase the understanding of the characteristics in different types of internal hernia, and improve the effect of surgical treatment. Methods We retrospectively analyzed 36 cases of internal hernia in The First Affiliated Hospital of Soochow University from January 2011 to December 2016. The clinical data of onset, diagnosis and surgical treatment process were reviewed and analyzed for each case, including past abdominal operation, duration time of internal hernia, gastrointestinal dysfunction before onset, preoperative diagnosis, intestinal necrosis, pathway of internal hernia, operation time, postoperative complications and postoperative mortality. Results Patients were divided into two groups, according to the condition that whether or not they had past abdominal operation. There was no significant statistical difference between the two groups in duration time of internal hernia, gastrointestinal dysfunction before onset, preoperative diagnosis, intestinal necrosis, pathway of internal hernia, and postoperative complications. However, there was a significant statistical difference between the two groups in operation time and postoperative mortality. The average operation time was significant more in no past abdominal operation group than in with past abdominal operation group (χ2=6.236, P=0.013); and the postoperative was significant higher in no past abdominal operation group (18.2%) than in with past abdominal operation group (χ2=4.67, P=0.031). Conclusion Past abdominal operation had no effect on the disease process and postoperative complications of internal hernia. However, the operation time and postoperative mortality were higher in no past abdominal operation group than in with past abdominal operation group. This may related to that the intestinal strangulation necrosis occurred at an early stage in internal hernia patients of no past abdominal operation group. Most of the patients manifested as unexplained ileus in the early stage of internal hernia. Timely exploratory laparotomy can help to improve the treatment effectiveness and reduce the postoperative mortality for the internal hernia patients manifested as irrelievable or recurrent intestinal obstruction. Key words: Abdominal internal hernia; Past abdominal operation; Intestinal obstruction; Intestinal necrosis