Do surgeons relieve obstruction or repair all hernias during emergency hernia repairs?

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Last updated: May 29, 2025 • View editorial policy

From the Guidelines

During emergency hernia repairs, the primary goal is to address the immediate life-threatening condition, which typically means relieving the obstruction or strangulation, and not attempting to fix all of the hernias. The surgeon should focus on reducing the incarcerated or strangulated contents, resecting any non-viable tissue, and performing a tension-free repair of the hernia that caused the emergency, as recommended by the 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias 1. Additional asymptomatic hernias discovered during the procedure are generally not repaired during the same emergency operation, as this approach minimizes operative time and reduces the risk of complications in an already compromised patient. The emergency repair should use the simplest, most reliable technique to address the acute problem, often involving mesh repair unless there is significant contamination from bowel perforation or necrosis, as supported by a retrospective study by Carbonell et al. 2. In contaminated fields, primary tissue repair may be preferred to avoid mesh-related infections, but the use of biological mesh prosthetics may offer a low-morbidity alternative to prosthetic mesh products in these complex settings, with good results also in immune-compromised patients, as suggested by a prospective study by Catena et al. 2. Once the patient has recovered from the emergency procedure, additional hernias can be evaluated and repaired electively when the patient is in optimal condition, as recommended by the WSES guidelines 1. This staged approach balances the need to address the immediate threat while minimizing operative risk in an emergency setting, and is supported by the literature, including a systematic review by Lee et al. 2. Some key points to consider in emergency hernia repairs include:

  • The use of mesh in clean surgical fields is associated with a lower recurrence rate, without an increase in the wound infection rate, as recommended by the WSES guidelines 1
  • In contaminated fields, the choice between a cross-linked and a non-cross-linked biological mesh should be evaluated depending on the defect size and degree of contamination, as suggested by a retrospective study by Han et al. 2
  • For unstable patients, open management is recommended to prevent abdominal compartment syndrome, and intra-abdominal pressure may be measured intraoperatively, as recommended by the WSES guidelines 1
  • Following stabilization of the patient, surgeons should attempt early, definitive closure of the abdomen, and primary fascial closure may be possible only when the risk of excessive tension or recurrent intra-abdominal hypertension is minimal, as recommended by the WSES guidelines 1.

From the Research

Emergency Hernia Repairs

  • The primary goal of emergency hernia repairs is to relieve obstruction and prevent life-threatening complications, such as strangulation and necrotic bowel 3, 4.
  • However, the approach to emergency hernia repairs can vary depending on the patient's condition, the type of hernia, and the surgeon's preference.
  • In some cases, surgeons may attempt to fix all hernias during an emergency repair, while in other cases, they may focus on relieving the obstruction and stabilizing the patient before considering further repair 5.

Factors Influencing Emergency Hernia Repairs

  • Patient factors, such as obesity, smoking history, and American Society of Anesthesiologists (ASA) class, can influence the outcome of emergency hernia repairs 3.
  • Hernia characteristics, such as defect size and bowel involvement, can also impact the complexity and outcome of emergency repairs 3, 6.
  • The presence of concomitant diseases, such as cardiopulmonary diseases, can increase the risk of mortality and morbidity in elderly patients undergoing emergency hernia repairs 4.

Surgical Approaches

  • Laparoscopic and open surgical approaches can be used for emergency hernia repairs, each with its own advantages and disadvantages 5.
  • The choice of surgical approach may depend on the patient's condition, the type of hernia, and the surgeon's experience and preference.
  • Laparoscopic approaches, such as the transabdominal preperitoneal (TAPP) technique, may be associated with shorter hospital stays and reduced postoperative complications in selected patients 5.

Outcomes and Complications

  • Emergency hernia repairs are associated with a higher risk of complications, such as surgical site infections, bowel resection, and mortality, compared to elective repairs 3, 4, 7.
  • The risk of recurrence is also higher in emergency repairs, particularly in patients with incisional hernias, recurrent hernias, and bowel involvement 3.
  • Bowel obstruction is a serious complication of femoral hernias, and patients with bowel obstruction tend to have longer hospital stays and higher morbidity and mortality rates 6.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.