Emergency incisional hernia repair (IHR) presents significant clinical challenges due to patient frailty, comorbidities, and risk of bowel obstruction or strangulation. This scoping review maps current evidence, highlighting variability in treatment approaches and the need for guideline development to optimize outcomes.
Background
Incisional hernias are common complications following abdominal surgery, with incidence rates ranging from 5% to over 20% depending on surgical factors and patient risk profiles. Emergency presentations often involve acute bowel obstruction or strangulation, requiring urgent intervention. Unlike elective repairs, emergency IHR is complicated by patient instability, contamination risk, and limited preoperative optimization. The use of mesh in contaminated fields remains controversial due to infection risks, and treatment strategies vary widely.
Data Highlights
The review included studies published between 2000 and August 2024, sourced from PubMed MEDLINE and SCOPUS, focusing on emergency IHR in adults. Outcomes assessed included morbidity, surgical site infections, reintervention rates, ICU admission, bowel resection, length of stay, mortality, and recurrence. Patient subgroups such as those with cirrhosis, obesity, COPD, diabetes, and immunocompromise were specifically considered. The evidence base remains heterogeneous with limited high-level data to guide emergency management.
Key Findings
Incidence of incisional hernias post-laparotomy ranges from 5% to 20%, higher in specific populations such as obese and colorectal surgery patients.
Emergency IHR is associated with worse outcomes compared to elective repair due to patient frailty and acute presentation.
Manual reduction (taxis) is attempted but often fails, necessitating immediate surgical intervention to prevent systemic inflammatory response and sepsis.
Use of mesh, while standard in elective repair, poses infection risks in contaminated emergency settings, complicating repair choices.
Patient stability, degree of bowel obstruction, and contamination severity are critical determinants of surgical approach and timing.
There is a paucity of high-quality evidence and consensus guidelines specifically addressing emergency IHR, underscoring the need for further research.
Clinical Implications
Clinicians should prioritize rapid assessment and stabilization of patients presenting with emergency incisional hernias, recognizing the high risk of bowel compromise and systemic complications. Surgical decision-making must balance the benefits of mesh reinforcement against infection risks in contaminated fields. Multidisciplinary management and individualized treatment plans are essential, especially in patients with significant comorbidities. The current evidence supports the urgent need for standardized guidelines to improve outcomes in this high-risk population.
Conclusion
Emergency incisional hernia repair remains a complex clinical challenge with limited evidence to guide optimal management. This scoping review highlights critical gaps and the necessity for focused research and guideline development to enhance patient care in emergency settings.
References
European Hernia Society Science Wing, 2024 -- Exploring Treatment Options for Emergency Incisional Hernia: A Scoping Review
by Andrea Carolina Quiroga-Centeno, Sebastian Schaaf, Ana Pilar Morante-Perea, Stavros A. Antoniou, Heather Bougard, Umberto Bracale, Sara Capoccia Giovannini, Eva Deerenberg, René H. Fortelny, Christine Gaarder, Miguel Ángel García-Ureña, Katie Gilmore, Sergio Alejandro Gomez-Ochoa, Ferdinand Köckerling, Maciej Pawlak, Francesca Pecchini, José A. Pereira-Rodriguez, Yohann Renard, Benoît Romain, Elena Schembari, Alexis Theodorou, Cesare Stabilini
