Abstract
BackgroundIncarceration of primary and incisional hernias often results in emergency surgery. The objective of this study was to evaluate the relation of defect size and location with incarceration. Secondary objectives comprised identification of additional patient factors associated with an incarcerated hernia.MethodsA registry-based prospective study was performed of all consecutive patients undergoing hernia surgery between September 2011 and February 2016. Multivariate logistic regression was performed to identify risk factors for incarceration.ResultsIn total, 83 (3.5%) of 2352 primary hernias and 79 (3.7%) of 2120 incisional hernias had a non-reducible incarceration. For primary hernias, a defect width of 3–4 cm compared to defects of 0–1 cm was significantly associated with an incarcerated hernia (OR 2.85, 95% CI 1.57–5.18, p = 0.0006). For incisional hernias, a defect width of 3–4 cm compared to defects of 0–2 cm was significantly associated with an incarceration (OR 2.14, 95% CI 1.07–4.31, p = 0.0324). For primary hernias, defects in the peri- and infra-umbilical region portrayed a significantly increased odds for incarceration as compared to supra-umbilical defects (OR 1.98, 95% CI 1.02–3.85, p = 0.043). Additionally, in primary hernias age, BMI, and constipation were associated with incarceration. In incisional hernias age, BMI, female sex, diabetes mellitus and ASA classification were associated with incarceration.ConclusionFor primary and incisional hernias, mainly defects of 3–4 cm were associated with incarceration. For primary hernias, mainly defects located in the peri- and infra-umbilical region were associated with incarceration. Based on patient and hernia characteristics, patients with increased odds for incarceration may be selected and these patients may benefit from elective surgical treatment.
Highlights
Abdominal wall hernias may result in pain, discomfort and aesthetic dissatisfaction and remain an important surgical challenge [1]
For primary and incisional hernias, mainly defects of 3–4 cm were associated with incarceration
Mainly defects located in the peri- and infra-umbilical region were associated with incarceration
Summary
Abdominal wall hernias may result in pain, discomfort and aesthetic dissatisfaction and remain an important surgical challenge [1]. Ascites, chronic cough, and constipation are factors that all have been reported to increase intra-abdominal pressure [4, 7,8,9] Hernia characteristics such as defect location and defect size may be associated with incarceration as well. Incarceration of primary and incisional hernias often results in emergency surgery. A defect width of 3–4 cm compared to defects of 0–2 cm was significantly associated with an incarceration (OR 2.14, 95% CI 1.07–4.31, p = 0.0324). Defects in the peri- and infra-umbilical region portrayed a significantly increased odds for incarceration as compared to supra-umbilical defects (OR 1.98, 95% CI 1.02–3.85, p = 0.043). BMI, female sex, diabetes mellitus and ASA classification were associated with incarceration
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