Inguinal hernia: challenging the traditional indication for surgery in asymptomatic patients

It is generally accepted that most inguinal hernias should be operated on electively in order to avoid the high morbidity and mortality associated with incarceration and small bowel obstruction. The present study reassesses the indication for surgery in asymptomatic inguinal hernia patients. We anal...

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Bibliographic Details
Published in:Hernia : the journal of hernias and abdominal wall surgery 2004-05, Vol.8 (2), p.117-120
Main Authors: Ohana, Gil, Manevwitch, Igor, Weil, Ruben, Melki, Yedidia, Seror, Dan, Powsner, Eldad, Dreznik, Zeev
Format: Article
Language:English
Subjects:
Aged
Elective Surgical Procedures
Emergencies
Hernia, Inguinal - complications
Hernia, Inguinal - diagnosis
Hernia, Inguinal - mortality
Hernia, Inguinal - surgery
Humans
Intestinal Obstruction - etiology
Intestine, Small
Middle Aged
Postoperative Complications
Retrospective Studies
Survival Rate
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Summary:It is generally accepted that most inguinal hernias should be operated on electively in order to avoid the high morbidity and mortality associated with incarceration and small bowel obstruction. The present study reassesses the indication for surgery in asymptomatic inguinal hernia patients. We analyzed profiles, separately, for elective and emergency inguinal herniorrhaphies and compared the morbidity and mortality rates. Two hundred randomly selected elective hernia repairs were compared with 67 incarcerated cases. Postoperative complications were more common following emergency (23.9%) than elective repair (10.5%); however, in both groups, minor complications predominated. The mortality rate in the incarcerated group (6%) was clearly linked with a high preoperative American Society of Anesthesiologists (ASA) score. A bowel resection rate of 4.5% was found in the incarcerated cases, which was not correlated with mortality. Patients with asymptomatic inguinal hernia and unfavorable medical conditions should be recommended an elective repair, preferably under local anesthesia, to avoid the high mortality associated with an emergency operation.
ISSN:1265-4906
1248-9204
DOI:10.1007/s10029-003-0184-3