Evaluation of The Factors Related To Strangulation and Mortality in Incarcerated Abdominal Wall Hernias

Abstract

Objective: In this five-year study, we aimed at investigating the factors related to strangulation and mortality in patients who underwent urgent surgery to treat incarcerated abdominal wall hernias. Methods: Patients presenting to the emergency department with an incarcerated abdominal wall hernia (incisional, umbilical, femoral, or inguinal) between October 2015and October 2019 were included in the study. The presence of intraoperative ischemia and necrosis was defined as “strangulation.” Depending on the presence or absence of strangulation in the incarcerated segment, patients were divided into two groups: Group 1 (nonstrangulated) and Group 2 (strangulated). Between the groups, length of time between incarceration and hospital admission, demographic and clinical data, and physical examination findings, Risk factors for strangulation and mortality were determined with univariate and multivariate analyses. Results: A total of 161 patients were enrolled in the study. Group 1 consisted of 119 patients and Group 2 consisted of 42 patients. In multivariate analysis, the prominent risk factors for strangulation were: high ASA score (p=0.008), acute abdomen findings with distension and elevated body temperature (p<0.001), delayed hospital admission (p<0.001), procalcitonin >0.5 ng/ml (p<0.001), D-Dimer > 500 µg/L (p<0.001), lactate > 2 mmol/L (p<0.001),and creatinine levels > 2 mg/dl (p<0.001). For mortality, the presence of strangulation (p<0.001), lactate levels > 2 mg/dl (p=0.004), and ASA scores > 3 (p =0.035) were the leading risk factors. Conclusion: The most significant risk factors for strangulation were delay of more than 48 hours, high procalcitonin, creatinine, lactate and D-Dimer levels while for mortality, strangulation, high lactate and ASA levels were significantly effective. Mortality rates may be lowered with an earlier diagnosis, more specifically, one made before the development of metabolic and radiologic impairment.