Presentation and outcome of incarcerated external hernias in adults.

BACKGROUND: Incarcerated external hernias are the second most common cause of small-intestinal obstructions. The purpose of this study was to examine the presentation and management of incarcerated external hernia. METHODS: The records of 385 consecutive patients undergoing emergency surgical operation for incarcerated external hernias in a large volume teaching hospital between August 1996 and October 1999 were analyzed. The patients' ages ranged from 15 to 100 years (mean 55.1). There were more men than women (250 and 135, respectively), and 165 (42.9%) patients were over 60 years of age. Inguinal and umbilical hernias were encountered most frequently, in 291 (75.5%) and 48 (12.5%) patients, respectively. The intestine was resected in 53 patients, 31 of whom were over 60 years of age (58.5%). Two hundred fifty-two (84.9%) patients presented 48 hours or more from the onset of symptoms. Significant concomitant diseases were noted in 52 men and 19 women. RESULTS: The overall complication rate amounted to 19.5%, major complications 15.1%. The most serious postoperative complications were pulmonary and cardiovascular. Adult respiratory distress syndrome developed in 10 patients, and congestive heart failure developed in 14 patients. Postoperative mortality was 2.9%. Nine (81.8%) of the dead patients were older than 60. Nine (81.9%) of the dead patients were admitted to hospital more than 24 hours after incarceration. Mortality was high in patients with serious coexisting diseases whereas morbidity was linked with the duration of symptoms prior to admission. CONCLUSIONS: Older age, severe coexisting diseases, and late hospitalization were the main causes of unfavorable outcomes of the management of incarcerated hernias.

Emergency hernia repairs in elderly patients.

BACKGROUND: Emergency hernia repairs comprise one of the most common procedures performed in elderly patients and also carry a high risk of mortality and morbidity. The aim of this study was to examine the factors that might have an influence on the outcome of emergency hernia repairs in elderly patients. METHODS: A review was made of 189 (120 male and 69 female) patients aged more than 65 years who underwent emergency hernia repair between December 1996 and January 2001 at the surgical emergency unit of our hospital. The patients' ages ranged from 65 to 100 years (mean 72.1). Concomitant diseases were present in 86 (45.5%) patients. Of 189 incarcerated hernias, there were 145 (76.7%) bowel obstructions and 91(48%) strangulations. Necrotic bowel was resected in 36(19%) patients. RESULTS: While overall mortality was 5%, it was found to be 19.4% after bowel resection. Major complications were observed in 48 (25%) patients. Mortality and morbidity were clearly linked with bowel resection. Coexisting cardiopulmonary diseases, misdiagnosis, American Society of Anesthesiologists class, and late admission were also found to be responsible for unfavorable outcomes. CONCLUSIONS: In elderly patients with external hernias early elective surgery should be preferred, and local anesthesia might be the best in order to avoid the increased risks of emergency hernia repairs.

Safety of colonic anastomosis following portal triad occlusion in rats.

Traumatic colon injuries frequently coexist with liver injury. Stopping the bleeding from hepatic pool may require complete portal triad occlusion. The possible effects of portal venous occlusion on healing of colonic anastomosis were examined using a rat model. A colo-colonic anastomosis following resection of a 1 cm segment of the transverse colon was done with just a simple manipulation on the liver and portal triad in the group A. In the group B the portal triad was clamped for 15 minutes. Then, the clamp was released for a thirty minutes reperfusion time. Subsequently, the same technique in the control group for colonic resection and anastomosis was applied. Ischemia/reperfusion resulted in histologically proven alterations in the large bowel in the group B. However, colonic tissue superoxide dismutase values showed no significant differences between the groups. On day 7, no differences were recorded in bursting pressures of the anastomoses and the hydroxyprolene levels of the anastomotic tissues of the two groups. These findings suggest that colonic anastomosis after portal triad occlusion is safe in the absence of peritonitis.