From the Guidelines
An incarcerated fat-containing hernia requires prompt surgical repair, and if strangulation is suspected, immediate emergency surgery is necessary. The decision to operate is based on the risk of progression to strangulation, which can lead to tissue necrosis and potentially life-threatening complications if left untreated 1.
Preoperative Management
Prior to surgery, the patient should be kept NPO (nothing by mouth), given IV fluids for hydration, and appropriate pain management with medications like morphine 2-4mg IV or hydromorphone 0.5-1mg IV as needed. Gentle manual reduction can be attempted by an experienced provider using adequate analgesia and muscle relaxation, but this should not delay definitive surgical management 1.
Surgical Approach
The surgical approach depends on the hernia location, with options including open or laparoscopic techniques. For patients with intestinal incarceration and no signs of intestinal strangulation or concurrent bowel resection, the use of mesh in clean surgical fields is associated with a lower recurrence rate without an increase in wound infection rate 1.
Postoperative Management
Postoperatively, patients typically require pain control with acetaminophen 1000mg every 6 hours and ibuprofen 600mg every 6 hours, with opioids as rescue medication. Early ambulation is encouraged to prevent complications.
Key Considerations
- Timing of Intervention: Patients should undergo emergency hernia repair immediately when intestinal strangulation is suspected (grade 1C recommendation) 1.
- Use of Mesh: The use of mesh in clean surgical fields (CDC wound class I) is associated with a lower recurrence rate, and for patients having a complicated hernia with intestinal strangulation and/or concomitant need of bowel resection without gross enteric spillage, emergent prosthetic repair with a synthetic mesh can be performed without an increase in 30-day wound-related morbidity (grade 1A recommendation) 1.
- Laparoscopic Approach: Diagnostic laparoscopy may be a useful tool for assessing bowel viability after spontaneous reduction of strangulated groin hernias, and repair of incarcerated hernias may be performed with a laparoscopic approach in the absence of strangulation and suspicion of the need for bowel resection (grade 2B and 2C recommendations) 1.
From the Research
Incarcerated Fat Containing Hernia Management
- The management of incarcerated hernias, including those containing fat, is a complex issue that requires prompt attention to prevent complications such as strangulation and bowel resection 2, 3.
- Studies have shown that elective repair of groin hernias can reduce the risk of incarceration and its associated morbidity and mortality 3.
- In cases where hernias are incarcerated, assessment and management options include reduction, surgical repair, and mesh placement 4.
- The use of mesh in the treatment of incarcerated hernias is a topic of debate, but some studies suggest that it can be safe and effective even in cases with bowel resection 5.
Surgical Approach
- Surgical repair of incarcerated hernias can be performed with or without mesh, and the choice of approach depends on various factors, including the type of hernia, patient comorbidities, and surgeon preference 5.
- A study of 166 patients who underwent emergency surgery for incarcerated hernia found that mesh placement was associated with a lower risk of complications in some cases 5.
- Another study reported a case of an incarcerated epigastric hernia that was successfully treated with anatomical repair and mesh reinforcement 6.
Complications and Risk Factors
- Incarcerated hernias are associated with a high risk of complications, including bowel resection, surgical site infections, and major morbidity 3, 5.
- Risk factors for complications include ASA grade 3/4, diabetes, cardiopathy, aspirin use, and bowel resection 5.
- Prompt recognition and treatment of incarcerated hernias can help reduce the risk of complications and improve patient outcomes 2, 3, 4.