STRANGULATED HERNIA: DOES SHORTER TIME TO THE OPERATING ROOM REDUCE THE OCCURENCE OF INTESTINAL NECROSIS?

Abstract

Surgical operations of abdominal wall hernias are one of the most common types of surgical procedures in general surgery. Being able to assess severity of a strangulated hernia (SH) in the acute setting would help the physicians and staff to easily triage and prioritize patients (pts.) in greater need of emergent care. By handling the pts. correctly and tending to their needs, complications such as intestinal necrosis (IN) and resection can be avoided, and postsurgical complications could be minimized. The morbidity following a surgical procedure does not only bring with it a social burden but also a financial burden for the pts. and the caregiver. Optimizing the care for SH will benefit all involved. There have been many case studies on hernias but so far, few authors have tried to tackle how to better manage pts. with strangulated hernia by retrospectively analyzing for time strangulation and blood parameters that could prove useful in assessing severity of irreversible ischemic damage of the incarcerated bowel. Purpose: The aim of this retrospective study was to collect and analyze data from Kaunas University Hospital (KUH), that could prove useful in correctly assessing severity of the SH to better prioritize pts. care and thereby decreasing risk of postoperative morbidity and mortality. Objectives: 1. To divide duration of strangulated hernia in different periods and analyse the time which could influence the occurrence of IN. 2. To determine a cut-off value linking duration of symptoms to when IN is more likely. 3. To identify the criteria and biomarkers this could predict the risk of IN occurrence for patients with SH. Methods: Patient data was collected from the Department of Surgery of Hospital of Lithuanian University of Health Sciences (LUHS) between years 2015 – 2020. The sample size of this study was 151 pts.: 66 males (43.7%) and 85 females (56.3%) Results and conclusions: We discovered that duration of symptoms is the most important variable having the highest influence on the risk of development of intestinal necrosis. Duration of > 12 hour in combination with age > 70 and increased inflammatory biomarkers, especially LDH acts as main predictive factor for development of necrosis and need for bowel resection. Once patient presented at the emergency room there seemed to be no delay that influenced the risk of necrosis.