A study on groin hernias presenting as acute surgical emergencies in adults

Authors

  • Sanjay Prakash J. Department of General Surgery, Saveetha Medical College, Saveetha University, Thandalam, 602105, Tamil Nadu, India
  • Anita Samraj Department of General Surgery, Saveetha Medical College, Saveetha University, Thandalam, 602105, Tamil Nadu, India
  • Muthukumaran G. Department of General Surgery, Saveetha Medical College, Saveetha University, Thandalam, 602105, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2349-2902.isj20175098

Keywords:

Herniorraphy, Inguinal hernia, Intestinal obstruction, Post-operative complications

Abstract

Background: Inguinal hernias form the commonest subgroup of various hernias; such common condition causes the problem of various complications. A minority of patients with a groin hernia present as an emergency, with a painful and irreducible mass or with intestinal obstruction and delay in presentation is known to result in high morbidity and mortality. Aim was to study about the various acute surgical emergencies in groin hernia with its complications and surgical treatments.

Methods: This study was a prospective observational study, conducted in the Department of General Surgery, Saveetha Medical College and Hospital, during March 2015 to February 2017. Thirty-five patients were included in the study. Ethical committee clearance was obtained prior to the commencement of study. All patients were studied from time of admission till discharge and followed up in out-patient department. A detailed history was elicited, and clinical examination was performed, and data recorded. All patients were given pre-and post-operative care.

Results: The incidence of hernia was 37.1% for age group of 60 to 69 years whereas it was 28.6% for age group of 50 to 59 years and incidence decreases there by as age decreases. The frequency of hernia in male (94.3%) was more when compared to female (5.7%). The duration of hernia frequency before acute episode was more in first year (54.3%). The right sided hernia was most complicated than left. The common site of constriction was deep inguinal ring than the superficial inguinal ring and femoral ring.

Conclusions: Majority of the patients underwent herniorraphy (82.8%). Most common site of constriction was observed to be at the deep ring (71.4%). The most common content was small bowel followed by omentum (74.3% and 25.7% respectively). Most of the patients did not have any post-operative complications (80%). Wound infection was the most common complication (11.5%) and mortality was observed in two patients (5.7%) and the causes of death were sepsis and acute respiratory distress syndrome.

Author Biography

Anita Samraj, Department of General Surgery, Saveetha Medical College, Saveetha University, Thandalam, 602105, Tamil Nadu, India

 

Thandalam - 602105.

References

Bali C, Tsironis A, Zikos N, Mouselimi M, Katsamakis N. An unusual case of a strangulated right inguinal hernia containing the sigmoid colon. International Journal of Surgery Case Reports. 2011;2(4):53-5.

Rai S, Chandra SS, Smile SR. A study of the risk of strangulation and obstruction in groin hernias. Aust N Z J Surg. 1998;68(9):650-4.

Khadilkar VV. IAP Growth Monitoring Guidelines for Children from Birth to 18 Years, Indian Pediatrics. 2007;44:187-97.

Primatesta P, Goldacre MJ. Inguinal hernia repair: incidence of elective and emergency surgery, readmission and mortality. Int J Epidemiol. 1996;25(4):835-9.

Bay-Nielsen M, Kehlet H, Strand L, Malmstrøm J, Andersen FH, Wara P. Quality assessment of 26,304 herniorrhaphies in Denmark: a prospective nationwide study. Lancet. 2001;358:1124-8.

Weber A, Garteiz D, Valencia S. Epidemiology of Inguinal Hernia: A Useful Aid for Adequate Surgical Decisions, Abdominal Wall Hernias Principles and Management, Springer Science Business Media New York: 2001:428-436.

Andrews MJ. Presentation and outcome of strangulated external hernia in a district general hospital. Br J Surg. 1981;68(3):29-32.

McEntee G, Pender D, Mulvin D, McCullough M, Naeeder S, Farah S, et al. Current spectrum of intestinal obstruction. Br J Surg. 1987;74(11):976-80.

Shakya VC, Agrawal CS, Adhikary S. A prospective study on clinical outcome of complicated external hernias. Health Renaissance. 2012;10(1):20-6.

Spangen L, Smedberg S. Nonpalpable Inguinal Hernia in Women. In: Abdominal Wall Hernias. Springer: New York, 2001:625-629.

Weber A, Valencia S, Garteiz D, Burgues A. Epidemiology of Hernia in the Female. In: Abdominal Wall Hernias, Bendavid R, Abrahamson J, Arregui M, Flament J, Phillips E (eds). Springer: New York. 2001:613-619.

Ljungdahl I. Inguinal and femoral hernia. Personal experience with 502 operations. Acta Chir Scand Suppl. 1973;439:1-81.

Phillips EH, Carroll BJ, Fallas MJ. Laparoscopic Preperitoneal Inguinal Hernia repair without Preperitoneal incision. Surg Endosc. 1993;17:159.

MacKenzie I, Management of strangulated hernia. Surg Clin North Am. 1960;40:1367.

Nixon SJ, Tulloh B. Abdominal Wall, Hernia and Umblicus, Chapter 60, Bailey and Love’s Short Practice of Surgery, 26th Edn, International Student’s Edition, Taylor and Francis Group, LLC; 2013:948-969.

Weber A, Valencia S, Garteiz D, Burgues A. Epidemiology of Hernia in the Female. In: Abdominal Wall Hernias, Bendavid R, Abrahamson J, Arregui M, Flament J, Phillips E (eds). Springer: New York; 2001:613-619.

Sandblom G, Haapaniemi S, Nilsson E. Femoral hernias: a register analysis of 588 repairs. Hernia 1999;3:131-4.

Gallegos NC, Dawson J. Risk of Strangulation in Groin Hernia. British Council Surg. 1991;78:171-3.

Frankau C. Strangulated hernia: a review of 1487 cases. Br Surg. 1931;19:176-91.

Williams J, Hale H. The advisability of inguinal herniorrhaphy in the elderly. Surg Gynaecol Obstet. 1966;122:100.

Amos R, Koontz MD. Femoral hernia: Operative cases at the John Hopkins Hospital during a twentyone year period. AMA Arch Surg. 1952;64:298-306.

Goyal S, Shrivastva M, Verma RK, Goyal S. Uncommon Contents of Inguinal Hernial Sac: A Surgical Dilemma. The Indian Journal of Surgery. 2015; 77(2): 305-9.

Rives J, Stoppa R, Fortesa L, et al. Les pieces en tulle de Dacron et leur place dans la chirurgie des hernies de l'aine. Ann Chir. 1968;22:159-171.

Pans A, Plumacker A, Legrand M Surgical treatment of crenal inguino hernias by interposition of prosthesis in preperitoneal condition. Acta ChiT Belg. 1991;91:223-6.

Stoppa R, Petitj, Abourachid H. Original procedure of hernia plasty of the groin: the interposition without fixation of a Dacron tulle prosthesis by median sub peritoneal route. Surgery. 1973;99:119-23.

Stoppa R, Warlaumont C. The preperitoneal approach and prosthetic repair of groin hernia. In Nyhus LM, Condon RE (eds): Hernia, 3rd ed. Philadelphia: J.B. Lippincott; 1989:199-221.

Wysocki A, Pozniczek M, Krzywon J, Bolt L, Use of polypropylene prostheses for strangulated inguinal and incisional hernias. Hernia. 2001;5(2):105-6.

John T Jenkins, Patrick J O’Dwyer, Inguinal hernias. BMJ. 2008;336:269-72.

Adesunkanmi AR, Agbakwuru EA, Badmus TA. Obstructed abdominal hernia at the Wesley Guild Hospital, Nigeria. East African Medical Journal. 2000;77(1).

Nesterenko IVA, Shovskii OL. Outcome of treatment of incarcerated hernia. Khirurgiia (Mosk). 1993;9:26-30.

Haapaniemi S, Sandblom G, Nilsson E. Mortality after elective and emergency surgery for inguinal and femoral hernia. 1999;4:205-8.

Dunphy JEJ. Influence of coexisting disease on complicated hernias. J Am Med Assoc. 1940;114:394.

McGugan E, Burton H, Nixon SJ, Thompson AM. Deaths following hernia surgery: Room for improvement. J R Coll Surg Edinb. 2000;45:183-6.

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Published

2017-11-25

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Original Research Articles