Current Surgical Management of the Acutely Incarcerated Ventral Hernia
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EMERGENCY GENERAL SURGERY (J DIAZ, SECTION EDITOR)
Current Surgical Management of the Acutely Incarcerated Ventral Hernia Jeremy H. Levin1 • Oliver L. Gunter1
Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Acutely incarcerated ventral hernias represent a complex disease process in an increasing complex population. Acute incarceration can lead to strangulation and worsen morbidity and mortality. Identifying best practices based upon available evidence is paramount to optimize patient outcomes. The following is a review of the most recent literature in the management of acutely incarcerated ventral hernias. Recent Findings Evidence suggests early intervention (\ 24 h) following incarceration mitigates the risk of strangulation and improves outcomes. The presence of ascites, an acute hernia angle, and bowel wall attenuation on computed tomography may help identify at risk patients. Fascial reinforcement with mesh is supported in hernias [ 3 cm, but evidence supporting synthetic or biologic mesh use is conflicting in clean-contaminated and contaminated cases. Summary Acutely incarcerated ventral hernias represent a complex disease process for which high-level evidence supporting best practices is sparse, and individualized surgical care can have significant impact on patient outcomes. Keywords Acute incarceration Emergency general surgery Mesh Complex abdominal wall This article is part of the Topical Collection on Emergency General Surgery. & Jeremy H. Levin [email protected] 1
Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, 1211 21st Ave S., Nashville, TN 37212, USA
Introduction The incidence of ventral hernias has been on the rise in the United States with approximately half a million abdominal hernia repairs performed between 2000 and 2010 [1]. According to an audit of 2006 data published by the Centers for Disease Control, the total cost for all ventral hernia repairs was $3.2 billion dollars [2]. In the case of emergency hernia repair, repair rates were the highest amongst adults 65 years or older with a near fourfold increase in the rates of emergent incisional hernia repairs amongst older men [2]. The natural history of abdominal wall hernias demonstrates that they increase in size over time. This poses an increased risk of complications including incarceration and strangulation which may result in need for emergency surgery [3, 4]. The risk factors for needing emergency surgery are endemic to a wide berth of emergency general surgery (EGS) patients and include patient comorbidities, poor socioeconomic status including poor access to healthcare, and advancing age [5, 6]. Predicting which ventral hernias may progress to acute incarceration is difficult, and hernias that go unrepaired may become incarcerated over time making patient education about risk factor modification (e.g., smoking cessation, weight loss, etc.) and signs of incarceration paramount [2, 7]. Neverth
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