Walid Ibrahim1, Jeremy Wilson2, Conor Magee2. 1. Department of Gastrointestinal Surgery, Arrowe Park University Teaching Hospital, Arrow Park Rd, Birkenhead, CH49 5PE, Wirral, UK. w.ibrahim1@nhs.net. 2. Department of Gastrointestinal Surgery, Arrowe Park University Teaching Hospital, Arrow Park Rd, Birkenhead, CH49 5PE, Wirral, UK.
Abstract
PURPOSE: Abdominal wall hernias are common in the UK and many present in an emergent fashion. The widespread introduction of computed tomography (CT) imaging has transformed surgical practice but out of hours access can be limited by hospital resources and introduce delays. We investigated the influence of preoperative CT imaging in acutely symptomatic hernia and the association with surgical delay and risks of bowel ischemia. METHODS: A retrospective analysis of patients undergoing emergency hernia surgery between 2013 and 2021 in a busy UK district general hospital. We evaluated the role of preoperative CT and its influence on timing of surgery, postoperative complications, critical care admission and hospital length of stay. RESULTS: Five hundred and five patients were studied. Of these, 191 had a preoperative CT scan. Sites of hernia included inguinal in 164 patients (33%); umbilical in 164 (33%); femoral in 69 (14%); incisional in 69 (14%); epigastric in 30 (6%) and Spigelian hernia 9 (2%). Preoperative CT imaging was associated with surgical delay (22.0 h vs 13.0 h, p < 0.001) and an increased need for bowel resection (12% vs 6%, p = 0.027). Delay in surgery was not associated with increased postoperative complications (5% vs 4%, p = 0.474) but was associated with increased critical care admission (11.0% vs 4.8%, p = 0.014). CONCLUSIONS: Preoperative CT scan for emergent hernias can delay often inevitable surgery and is associated with an increasing need for more complex, resectional surgery .
PURPOSE: Abdominal wall hernias are common in the UK and many present in an emergent fashion. The widespread introduction of computed tomography (CT) imaging has transformed surgical practice but out of hours access can be limited by hospital resources and introduce delays. We investigated the influence of preoperative CT imaging in acutely symptomatic hernia and the association with surgical delay and risks of bowel ischemia. METHODS: A retrospective analysis of patients undergoing emergency hernia surgery between 2013 and 2021 in a busy UK district general hospital. We evaluated the role of preoperative CT and its influence on timing of surgery, postoperative complications, critical care admission and hospital length of stay. RESULTS: Five hundred and five patients were studied. Of these, 191 had a preoperative CT scan. Sites of hernia included inguinal in 164 patients (33%); umbilical in 164 (33%); femoral in 69 (14%); incisional in 69 (14%); epigastric in 30 (6%) and Spigelian hernia 9 (2%). Preoperative CT imaging was associated with surgical delay (22.0 h vs 13.0 h, p < 0.001) and an increased need for bowel resection (12% vs 6%, p = 0.027). Delay in surgery was not associated with increased postoperative complications (5% vs 4%, p = 0.474) but was associated with increased critical care admission (11.0% vs 4.8%, p = 0.014). CONCLUSIONS: Preoperative CT scan for emergent hernias can delay often inevitable surgery and is associated with an increasing need for more complex, resectional surgery .
Authors: Ira L Leeds; Christian Jones; Sandra R DiBrito; Joseph V Sakran; Elliott R Haut; Alistair J Kent Journal: Surg Endosc Date: 2019-11-18 Impact factor: 4.584
Authors: Mustafa Ozbagriacik; Gurhan Bas; Fatih Basak; Abdullah Sisik; Aylin Acar; Ilyas Kudas; Metin Yucel; Adnan Ozpek; Orhan Alimoglu Journal: North Clin Istanb Date: 2015-04-24
Authors: Arianna Birindelli; Massimo Sartelli; Salomone Di Saverio; Federico Coccolini; Luca Ansaloni; Gabrielle H van Ramshorst; Giampiero Campanelli; Vladimir Khokha; Ernest E Moore; Andrew Peitzman; George Velmahos; Frederick Alan Moore; Ari Leppaniemi; Clay Cothren Burlew; Walter L Biffl; Kaoru Koike; Yoram Kluger; Gustavo P Fraga; Carlos A Ordonez; Matteo Novello; Ferdinando Agresta; Boris Sakakushev; Igor Gerych; Imtiaz Wani; Michael D Kelly; Carlos Augusto Gomes; Mario Paulo Faro; Antonio Tarasconi; Zaza Demetrashvili; Jae Gil Lee; Nereo Vettoretto; Gianluca Guercioni; Roberto Persiani; Cristian Tranà; Yunfeng Cui; Kenneth Y Y Kok; Wagih M Ghnnam; Ashraf El-Sayed Abbas; Norio Sato; Sanjay Marwah; Muthukumaran Rangarajan; Offir Ben-Ishay; Abdul Rashid K Adesunkanmi; Helmut Alfredo Segovia Lohse; Jakub Kenig; Stefano Mandalà; Raul Coimbra; Aneel Bhangu; Nigel Suggett; Antonio Biondi; Nazario Portolani; Gianluca Baiocchi; Andrew W Kirkpatrick; Rodolfo Scibé; Michael Sugrue; Osvaldo Chiara; Fausto Catena Journal: World J Emerg Surg Date: 2017-08-07 Impact factor: 5.469