An abdominal hernia is the protrusion of abdominal content through a defect in the abdominal wall. Abdominal hernias are quite common. Every year, there are approximately 700,000 hernia operations performed in the United States, according to 2007 information from the Merck Manuals Online Medical Library. At first, a hernia can be reduced inside the abdomen by the patient. Later, the hernia may become trapped or stuck and cannot be pushed back in the abdomen; the hernia is considered incarcerated at this point. An incarcerated hernia requires urgent surgical repair.
Problems from Anesthesia
As noted by the National Digestive Diseases Information Clearinghouse, swelling of the herniating tissue is the usual cause of an incarcerated hernia. This swelling can eventually cut off the blood supply, causing a strangulated hernia. A strangulated hernia is a medical emergency due to the imminent threat of obstruction of the intestinal lumen, which can cause vomiting and abdominal pain, and can become life threatening; the affected intestine may die. An article in the January 2009 issue of the journal "Hernia" explains that emergency repair of incarcerated hernias carries more risk of complications for vulnerable populations such as the elderly. In the study discussed, because the surgery was an emergency, the patients were not properly prepped for anesthesia, drastically increasing the rate of anesthetic complications.
Recurrence
A paper published in the November 2009 issue of the "Journal of Surgical Endoscopy" notes that the rate of recurrence after traditional surgical repair of the incarcerated hernia is very high. This is because of the difficulty of application of proper technique to the swollen tissues. Recurrent hernias are more prone to complications, including incarceration, because of the excessive scar tissue at the site of the incision.
Infection
The use of a synthetic mesh to reinforce the weakened abdominal wall and to close the defect has become standard surgical practice to reduce the risk of recurrence. However, as highlighted by a 2009 study in the" Journal of Surgical Endoscopy," sometimes a reduced blood supply due to a loop of the bowel may be missed during the surgery for incarcerated hernia. If mesh is implanted in this site of compromised blood supply, it can become contaminated and cause a troublesome postoperative infection.
References
- Merck Manuals Online Medical Library: Abdominal Hernias.
- "Hernia"; Incarcerated hernia: to reduce or not to reduce? ; H. V. Harris et al.; January 2009.
- "Journal of Surgical Endoscopy"; The combined laparoscopic approach for the treatment of incarcerated inguinal hernia; Aviad Hoffman et al.; November 2009.
- National Digestive Diseases Information Clearinghouse: Inguinal Hernia
