A manual reduction of hernia under analgesia/sedation (Taxis) in the acute inguinal hernia: a useful technique in COVID-
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REVIEW
A manual reduction of hernia under analgesia/sedation (Taxis) in the acute inguinal hernia: a useful technique in COVID‑19 times to reduce the need for emergency surgery—a literature review B. East1,2 · M. Pawlak3 · A. C. de Beaux4 Received: 28 April 2020 / Accepted: 25 May 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Background Acute IH is a common surgical presentation. Despite new guidelines being published recently, a number of important questions remained unanswered including the role of taxis, as initial non-operative management. This is particularly relevant now due to the possibility of a lack of immediate surgical care as a result of COVID-19. The aim of this review is to assess the role of taxis in the management of emergency inguinal hernias. Methods A review of the literature was undertaken. Available literature published until March 2019 was obtained and reviewed. 32,021 papers were identified, only 9 were of sufficient value to be used. Results There was a large discrepancy in the terminology of incarcerated/strangulated used. Taxis can be safely attempted early after the onset of symptoms and is effective in about 70% of patients. The possibility of reduction en-mass should be kept in mind. Definitive surgery to repair the hernia can be delayed by weeks until such time as surgery can be safely arranged. Conclusions The use of taxis in emergency inguinal hernia is a useful first line of treatment in areas or situations where surgical care is not immediately available, including the COVID-19 pandemic. Emergency surgery remains the mainstay of management in the strangulated hernia setting. Keywords Inguinal hernia · Incarcerated · Strangulated · Surgery
Introduction Patients presenting with an acute inguinal hernia (IH) remain a common surgical emergency. The popular “watch and wait” policy for IH is increasing the emergency presentation * B. East [email protected] M. Pawlak [email protected] A. C. de Beaux [email protected] 1
3rd Department of Surgery, 1st Faculty of Medicine, Charles University, Motol University Hospital, V uvalu 84, Prague 5, 15006 Prague, Czech Republic
2
2nd Faculty of Medicine, Charles University, Prague, Czech Republic
3
Northern Devon Healthcare NHS Trust, Barnstaple, UK
4
Department of General Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
of such hernias [1]. The management of such patients is associated with significant morbidity and indeed mortality. The recently published HerniaSurge guidelines [2] on groin hernias included a short chapter on the emergency groin hernia. However, a number of important questions relating to the management of such patients remain, and the role of taxis (manual reduction of a hernia under analgesia/sedation) was not mentioned. Furthermore, the WSES guidelines for emergency repair of complicated abdominal wall hernias and their recent update does not mention taxis either [14]. In the acute painful IH, as long as it is reducible, there is no surgical emergency. Howeve
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