Hernioplasty is a procedure associated with specific types of complications and risk of recurrence. The numbers may vary depending on the used technique and accompanying risk factors (1, 2). Although, all types of hernias have a recommendation for elective procedure, incarceration or strangulation are often causes of admission to the surgical wards. Among all types of abdominal wall hernias, inguinal, femoral, epigastric and umbilical hernias carry the greatest risk of incarceration (3). Strangulated hernias are unable to be reduced manually and need emergency surgery. Emergency status of the operation increases the morbidity and mortality. Incarcerated hernia is one of the main indication for intestinal resection (4, 5). Many studies evaluate the factors affecting outcomes of emergency hernioplasty (6-8). Despite rapid development of methods of elective hernias repair, an emergency hernioplasty can be challenging for the surgeon. This group of patients requires careful attendance and adequate follow-up.

We would like to present a retrospective analysis of cases of incarcerated hernias treated in our clinic.

We analyzed retrospectively patients operated in Department of General, Oncological and Gastrointestinal Surgery in Orlowski Hospital Medical Center for Postgraduate Education in Warsaw between January 2010 and December 2013. Patients data was gathered from the medical records and operating room records. Patients follow-up was obtained from outpatient surgical clinic records and by phone survey. The following variables were analyzed: age, sex, hernia type, symptoms at the admission, comorbidities, past medical history, Body Mass Index (BMI), American Society of Anesthesiologists (ASA) class, duration of surgical procedure, contents of the hernial sac, method of hernia repair, duration of hospital stay, complications and mortality.

Between January 2010 and December 2013, sixteen patients (3%) underwent emergency hernia repair out of 490 admitted and operated for inguinal hernia. Femoral hernia repair had urgent status in two cases out of 13 patients (15%). Mean age was 61 years (range 21 to 88). There were 14 male and 4 female. Two patients were diagnosed with groin hernia. Mean duration of hospital stay was 4 days (range 3 to 6). Dominating symptoms were abdominal pain (18/18), nausea and vomiting (5/18), irreducible manually mass in the inguinal region (3/18) and flatulence (3/18). Comorbidities were noted in 13 patients (hypertension, diabetes, ulcer disease, epilepsy, cardiac dysrhythmia). Two patients had previously elective hernia repair and was admitted with a recurrence. Mean BMI was 25 kg/m² (range from 19 to 30 kg/m²). Blood tests prior to operation evaluated leukocytosis in 7 cases. 8 patients were operated with ASA class II, 5 patients with ASA class III. Lichtenstein hernia repair was performed in 4 cases, Shouldice method in 4 cases, Halstead method in 4 cases, Basini method in 1 case, 3 patients had anatomic hernia repair. Content of the hernia sac was ileum (7/18), omentum (3/18), colon (2/18), urinary bladder (2/18) and preperitoneal tissue (1/18). None of the patients required necrotic bowel resection. Mean duration of the surgery was 92 minutes (range 60 to 180). Major complications were noted in 2 cases. There was one reoperation in the first postoperative day because of bleeding from the wound. One patient, 2 months after hernia repair, required bowel resection secondary to iatrogenic perforation. Postoperative mortality was noted in one patient who had significant coexisting disease (2 years after hernia repair). No deaths related to hernia surgery was recorded. No hernia recurrence was observed.

Between January 2010 and December 2013, 116 patient underwent epigastric hernia repair, out of whom five had emergency operation (4.3%). Mean age was 51 years (range from 28 to 80), two were male. Hospital stay ranged from 3 to 5 days. Dominating symptom at the admission to the hospital was abdominal pain (5/5), 2 patients complained additionally about nausea. Comorbidities were recorded in 4 patients (arterial hypertension, diabetes, Hashimoto disease). One patient, 3 years before admission, underwent elective surgery of epigastric hernia. Mean BMI was 32 kg/m² (range from 25 to 40 kg/m²). Three patients blood tests revealed leukocytosis. Three patients were operated with ASA class II, one case of ASA class III. Hernia sac in 2 cases contained ileum, colon and preperitoneal tissue in one case each. Mean operating time was 85 minutes (range 50 to 140 minutes). Post-dural-puncture headache was the only postoperative complication, observed in one case. No major complication, no deaths, no recurrence were noted in the follow-up.

In the analyzed period, 69 patients had umbilical hernia repair, 3 procedures (4%) were performed as an emergency. Mean age was 53 years (range 22 to 83), 2 were male. Hospital stay ranged from 3 to 5 days. All of the patients complained about abdominal pain, one also about nausea and vomiting. Each patient had coexisting diseases (arterial hypertension, alcoholism, Prader-Willi syndrome). Mean BMI was 36 kg/m² (range from 27 to 56 kg/m²). One patient was operated with ASA class III, one case of ASA class II. Ileum was found in hernia sac in 1 patient, in 2 cases it contained omenutum, which once had to be resected. Mean duration of the surgery was 63 minutes (range 30 to 100). One patient, with Prader-Willi syndrome and significant high BMI (56 kg/m²), required reoperation 4 months after the primary hernia repair. This patient was diagnosed with subcutaneous fluid collection, which was drained successfully. No deaths, no recurrence of the hernia were observed in the follow-up.

Indications for emergency hernia operation has been widely discussed in the literature, mainly because of a high probability of complications, which increase the mortality rate. A large number of articles published recently gives an impression of rapid development of minimally invasive surgery in the emergency treatment of abdominal wall hernias.

In total, 24 papers were reviewed in our article. Most of the authors (17) focus on emergency surgery of groin hernias. Only 6 articles covered all types of abdominal wall hernias. Only one paper focused on ventral hernias. 16 articles discuss open methods of abdominal wall hernias surgery, 13 of which refer to inguinal hernias and only 3 concern open surgery of acute abdominal and groin hernias. 9 articles focus on minimally invasive methods used in diagnosing acute hernias, out of which 8 refer to groin hernias and one concern abdominal and groin hernias. One paper compares open and minimally invasive surgery of acute groin hernias. Only one article describes minimally invasive treatment of acute abdominal wall hernias.