Presentación y evolución clínica de las hernias externas incarceradas en pacientes adultos / Presentation and outcome of incarcerated external hernias in adults

Objetivo. Estudiar la presentación y la evolución clínica de pacientes adultos con hernias externas incarceradas y tratar de identificar los factores que podrían tener algún efecto en su curso evolutivo. Pacientes y método. Se ha revisado retrospectivamente a 230 pacientes adultos intervenidos de urgencia por una hernia externa incarcerada durante el período 1992-2001. Se estudiaron las características de la presentación clínica, el tipo de anestesia, los métodos quirúrgicos, las complicaciones y la mortalidad. También se realizó un análisis univariable para determinar los factores con posible influencia en la evolución clínica. Resultados. Hubo 77 hernias crurales, 70 inguinales, 43 umbilicales y 40 eventraciones. Un total de 74 enfermos (32,2%) acudió con más de 48 h de evolución. En 135 pacientes (58,7%) había enfermedades asociadas significativas. En 140 pacientes (60,9%) se usó anestesia general, en 86 raquianestesia y en 4 anestesia local. Los métodos quirúrgicos más utilizados fueron la reparación anatómica y la hernioplastia sin tensión. En 31 casos (13,5%) fue necesaria una resección intestinal. Las tasas de morbilidad global y mayor y de mortalidad fueron del 37,8, el 10 y el 3,9%, respectivamente. Los factores asociados de manera significativa con una evolución desfavorable fueron una sintomatología prolongada, la hospitalización tardía, la presencia de enfermedades asociadas y un grado ASA alto. Conclusiones. El tratamiento urgente de las hernias externas conlleva una elevada morbimortalidad, por lo que un diagnóstico precoz y la reparación electiva de las hernias no complicadas deberían ser la estrategia terapéutica adecuada en los pacientes adultos (AU)

Objective. The aim of this study was to determine the clinical presentation and outcome of incarcerated external hernias in adults, as well as to identify the factors that might have some influence on outcome. Patients and method. A retrospective study of 230 adult patients who underwent emergency surgical repair of incarcerated external hernias from 1992 to 2001 was performed. The characteristics of clinical presentation, type of anesthesia, surgical procedures, complications and mortality were studied. To determine clinical factors that might have some influence on outcome, an univariate analysis was also performed. Results. There were 77 femoral hernias, 70 inguinal, 43 umbilical and 40 incisional hernias. Seventy-four patients (32.2%) presented after 48 h of symptom onset. Significant associated diseases were found in 135 patients (58.7%). General anesthesia was used in 140 patients (60.9%), spinal anesthesia in 86 patients and local anesthesia in four patients. The most commonly used procedures were anatomic repair and tension-free hernioplasty. Bowel resection was required in 31 patients (13.5%). Overall and major morbidity and mortality were 37.8%, 10% and 3.9%, respectively. Factors that were significantly associated with unfavorable outcome were longer duration of symptoms, late hospitalization, concomitant diseases, and a high ASA class. Conclusions. External hernias produce elevated morbidity and mortality if treatment is undertaken as an emergency. Thus, early diagnosis and elective repair of uncomplicated hernias should be performed in adults (AU)

[Presentation and outcome of incarcerated external hernias in adults]. / Presentación y evolución clínica de las hernias externas incarceradas en pacientes adultos.

OBJECTIVE: The aim of this study was to determine the clinical presentation and outcome of incarcerated external hernias in adults, as well as to identify the factors that might have some influence on outcome. PATIENTS AND METHOD: A retrospective study of 230 adult patients who underwent emergency surgical repair of incarcerated external hernias from 1992 to 2001 was performed. The characteristics of clinical presentation, type of anesthesia, surgical procedures, complications and mortality were studied. To determine clinical factors that might have some influence on outcome, an univariate analysis was also performed. RESULTS: There were 77 femoral hernias, 70 inguinal, 43 umbilical and 40 incisional hernias. Seventy-four patients (32.2%) presented after 48 h of symptom onset. Significant associated diseases were found in 135 patients (58.7%). General anesthesia was used in 140 patients (60.9%), spinal anesthesia in 86 patients and local anesthesia in four patients. The most commonly used procedures were anatomic repair and tension-free hernioplasty. Bowel resection was required in 31 patients (13.5%). Overall and major morbidity and mortality were 37.8%, 10% and 3.9%, respectively. Factors that were significantly associated with unfavorable outcome were longer duration of symptoms, late hospitalization, concomitant diseases, and a high ASA class. CONCLUSIONS: External hernias produce elevated morbidity and mortality if treatment is undertaken as an emergency. Thus, early diagnosis and elective repair of uncomplicated hernias should be performed in adults.