Clinical Scorecard: Exploring Treatment Options for Emergency Incisional Hernia: A Scoping Review
At a Glance
Category
Detail
Condition
Emergency incisional hernia (IH)
Key Mechanisms
Abdominal wall defect leading to bowel obstruction and/or strangulation causing systemic inflammatory response and sepsis
Target Population
Adult patients presenting with emergency incisional hernia, often frail with comorbidities
Care Setting
Emergency department and surgical care settings requiring urgent intervention
Key Highlights
Incisional hernias occur in 5–20% of laparotomy cases, higher in abdominal aortic aneurysm repair, obesity, and colorectal surgery.
Emergency IH repair outcomes are worse than elective repair due to patient frailty, comorbidities, and urgent presentation with bowel obstruction or strangulation.
Use of mesh is gold standard in elective repair but poses infection risks in contaminated emergency settings.
Guideline-Based Recommendations
Diagnosis
Prompt recognition of acute incarceration and bowel obstruction symptoms is critical.
Immediate surgical repair indicated if manual reduction fails or is inappropriate.
Treatment choice depends on patient stability, bowel obstruction severity, and contamination level.
Consider alternatives to open repair based on hernia morphology, localization, patient condition, and local expertise.
Cautious use of mesh in contaminated or dirty surgical fields due to infection risk.
Monitoring & Follow-up
Close postoperative monitoring for complications including surgical site infection, mesh infection, and systemic inflammatory response.
Assessment of morbidity, ICU admission, reintervention, and readmission rates.
Risks
Higher risk of postoperative complications due to patient frailty, comorbidities, and ongoing therapies like anticoagulation or steroids.
Progression to systemic inflammatory response and sepsis if surgical intervention is delayed.
Mesh colonization risk in contaminated emergency repairs.
Patient & Prescribing Data
Adult emergency incisional hernia patients, including high-risk groups such as elderly, obese, cirrhotic, COPD, diabetic, immunocompromised, and those on anticoagulation or steroids.
Urgent surgical repair tailored to patient condition and contamination status; mesh use balanced against infection risk.
Clinical Best Practices
Early diagnosis and timely surgical intervention to prevent progression to sepsis.
Individualized treatment planning considering patient comorbidities and hernia characteristics.
Avoidance or cautious use of mesh in contaminated surgical fields.
Multidisciplinary approach involving general and abdominal wall surgeons with expertise in emergency hernia repair.
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
