What is the diagnosis and treatment for a hernia?

From the Guidelines

Patients with suspected intestinal strangulation due to a hernia should undergo emergency hernia repair immediately, as early intervention is critical in reducing morbidity and mortality rates. This recommendation is based on the 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias 1. The guidelines emphasize the importance of prompt surgical intervention in cases of suspected bowel strangulation, as delayed diagnosis can lead to septic complications and increased mortality rates.

Key factors that influence the outcome of emergency hernia repair include:

• Timing of intervention: Early surgical intervention is crucial in reducing morbidity and mortality rates 1
• Presence of intestinal strangulation: Strangulated hernias require immediate surgical attention to prevent further complications 1
• Use of mesh: The use of mesh in emergency hernia repair is still a topic of debate, with some studies suggesting that it may increase the risk of wound infection 1
• Patient factors: Comorbidities, age, and overall health status can impact the outcome of emergency hernia repair 1

In terms of diagnostic methods, laboratory parameters such as lactate levels, serum creatinine phosphokinase (CPK), and D-dimer levels can be useful in predicting bowel strangulation 1. Imaging studies, such as computed tomography (CT) scans, can also help identify signs of bowel strangulation, including reduced wall enhancement and free fluid in the abdominal cavity.

Postoperative care is also crucial in reducing complications and promoting recovery. Patients should be closely monitored for signs of infection, and pain management should be tailored to individual needs. Patients should avoid heavy lifting and strenuous activities for 4-6 weeks after surgery to prevent recurrence and promote healing. Overall, a multidisciplinary approach to emergency hernia repair, including prompt surgical intervention, careful patient selection, and meticulous postoperative care, is essential in reducing morbidity and mortality rates associated with this condition.

From the Research

Definition and Diagnosis of Hernia

• A hernia is a defect of the abdominal wall in the groin area, comprising inguinal and femoral hernias 2.
• Inguinal hernias are more common in men, and diagnosis is often made on physical examination, while ultrasonography is used in women or when a recurrent hernia is suspected 2.
• Magnetic resonance imaging has higher sensitivity and specificity than ultrasonography and is useful for diagnosing occult hernias 2.

Treatment Options for Hernia

• Laparoscopic repair is associated with shorter recovery time, earlier resumption of activities of daily living, less pain, and lower recurrence rates than open repair 2, 3.
• Watchful waiting is a reasonable and safe option in men with asymptomatic or minimally symptomatic inguinal hernias, but not recommended in patients with symptomatic hernias or in nonpregnant women 4, 2.
• The totally extraperitoneal patch plasty (TEP), transabdominal preperitoneal patch plasty (TAPP), and Lichtenstein techniques are recommended by the international hernia societies 3.

Postoperative Care and Complications

• Postoperative complications such as chronic pain and recurrence can occur after hernia repair, with a lifetime risk of 27-43% for men and 3-6% for women 3.
• Preoperative administration of IV ibuprofen did not significantly reduce postoperative pain among patients undergoing elective hernia repair 5.
• A tailored approach in inguinal hernia repair should pay heed to patient- and hernia-related factors, such as unilateral hernia, bilateral hernia, recurrent hernia, and scrotal hernia 3.

New Techniques and Approaches

• The SubCutaneous OnLay endoscopic Approach (SCOLA) mesh repair is a new technique for addressing small midline ventral hernias with diastasis recti, showing promising results in initial US experience 6.
• This technique involves a hybrid procedure combining hernia repair with anterior plication of diastasis recti, and has been shown to be safe and effective in a prospective cohort of patients 6.