310 Incarcerated incisional hernias should be managed surgically where possible, despite a high incidence of obesity and comorbidity: a 7-year experience in a District General Hospital

Aims

Incisional hernia (IH) is a common complication of major abdominal surgery. This study describes the outcomes and burden of emergency management of incisional hernias.

Methods

A retrospective single-centre observational study was conducted on all patients with an incarcerated incisional hernia over seven years. Patient demographics, comorbidities, presentation mode, radiological imaging and management were analysed. Outcome measures were: postoperative complications, need for Level 2 or 3 care, mortality rates, hospital stay, readmission rates and hernia recurrence.

Results

194 patients were identified, of whom 54 were excluded. For the 137 patients analysed, the mean age was 66.54 SD± 14.6 with a median of 67 years; 80 (58 %) were females. The mean BMI was 34.6 SD± 10.08 kg/m2.

43 % had at least one comorbidity. 69 (57.7%) patients presented with small bowel obstruction, of whom 3 (2.2%) had bowel perforation. Over two-thirds of patients (93, 67.9%) were managed surgically, with 44 (32.1%) being managed conservatively.

The significant complication (Clavien-Dindo III and over) rate was 16.1%, and the most common complications were wound-related. The 30-day and 90-day mortality rates were 6.6% and 8.8%, respectively. The mean length of stay was 12 days SD± 25. Some 19.7% needed Level 2 or 3 care, and 24.1% had unplanned readmissions, the majority of whom were in the conservatively managed group.

Conclusion

Patients with complicated IH have significant comorbidities, and many are obese. Emergency presentation of IH carries a high risk of morbidity. High readmission rates are seen in conservatively managed patients, and surgical repair should be undertaken where possible.