Page 90 - International guidelines for groin hernia management

Hernia

Key question • ASA class III and IV, BMI [ 30, and recurrent hernia 30
and
KQ21.b Which risk factors increase morbidity and mor- • Anticoagulant use 307
tality in adults with incarcerated/strangulated groin
One study group has proposed a classification scheme to
hernias?
objectively reflect the degree of clinical and morphological

Evidence in literature changes in acutely incarcerated bowel. They found that
Morbidity and mortality are increased amongst incarcer- acute incarceration time was the strongest predictor of
ated/strangulated adult groin hernia patients with the fol- bowel damage and subsequent infection. They also found
lowing risk factors. that outcomes were worse in older patients, especially
those with comorbidities and higher ASA scores. 312
138,
30,
308
305,
306,
• Age [ 65 years, especially
octogenarians 309 Discussion
• Prolonged symptom duration 305
• Delay to admission, diagnosis, and surgery 22 The statement is graded as low evidence, because the
• Prolonged time from admission to start of surgery 308 available evidence leaves appreciable uncertainty about the
• Incarceration for more than 24 h 310 magnitude of the effects of the various risks cited. More
• Symptom duration of 3 or more days 307 study in this area is clearly needed.
• Bowel obstruction 308
• Lack of health insurance 308 Key question
• Associated midline laparotomy for exploration after
incarcerated/strangulated hernia reduction 311 KQ 21.c Which diagnostic method is most suitable for the
• Femoral hernia, 30, 305–308 especially right-sided 306 detection of incarcerated/strangulated groin hernias in
• Female gender 138, 304, 305 adults?

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