Evaluation and clinical significance of predictors for strangulation and intestinal resection in emergency anterior abdominal wall hernia surgery

BACKGROUND: Emergency anterior abdominal wall hernia surgery plays a pivotal role in emergency general surgery practice. In this study, the predictive value of laboratory and imaging findings as well as demographic information and comorbidities of the patients for the recognition of strangulation and intestinal resection was investigated.
METHODS: Patients over the age of 18 who were operated consecutively with an indication for emergency anterior abdominal wall hernia surgery between January 2017 and December 2019 in a single tertiary hospital were included in this retrospective cohort study. The patient population was divided into two groups according to the pre-operative findings during the emergency anterior abdominal wall hernia surgery. Group 1 consisted of cases with incarceration but without strangulation, whereas Group 2 consisted of cases with strangulation in addition to incarceration. Moreover, in evaluation for the requirement for intestinal resection, patient Group 2 was divided further into two groups, namely, as Group (1 or 2) a and Group (1 or 2) b, defining the need for intestinal resection.
RESULTS: A total of 106 patients who had emergency anterior abdominal wall repair surgery due to incarcerated hernias were included in the study. The evaluation of the indices related to systemic inflammation revealed that lactate dehydrogenase to white blood cell ratio was significantly lower but neutrophil to platelet and neutrophil to albumin ratios were significantly higher in patients with strangulation, showing the significance of those systemic inflammation indices in detecting strangulation (p=0.027, p=0.035 and p=0.030, respectively). Moreover, the analysis of the patients in whom intestinal resection was required (Group 2a vs. 2b) exposed that neutrophil to albumin ratio was significantly higher in the patients with intestinal resection (p=0.036).
CONCLUSION: Indices of systemic inflammation such as lactate dehydrogenase to white blood cell ratio, neutrophil to platelet ratio, and particularly neutrophil to albumin ratio may be potentially beneficial to prevent complications and improve clinical outcomes in emergency hernia surgery.

Acil karýn ön duvarý fýtýðý cerrahisinde strangülasyon ve intestinal rezeksiyon prediktörlerinin deðerlendirilmesi ve klinik önemi

AMAÇ: Acil karýn ön duvarý fýtýðý cerrahisi, acil genel cerrahi pratiðinde çok önemli bir rol oynamaktadýr. Bu çalýþmada, hastalarda strangülasyon ve intestinal rezeksiyonun tanýnmasýnda laboratuvar ve görüntüleme bulgularýnýn yaný sýra demografik bilgilerinin ve komorbiditelerinin prediktif deðeri araþtýrýldý.
GEREÇ VE YÖNTEM: Bu geriye dönük kohort çalýþmasýna, Ocak 2017 ve Aralýk 2019 tarihleri arasýnda acil karýn ön duvarý fýtýðý ameliyatý endikasyonu ile üçüncü basamak bir hastanede ameliyat edilen 18 yaþ üstü hastalar alýndý. Hasta popülasyonu acil karýn ön duvarý fýtýðý operasyonunda peroperatif bulgulara göre iki gruba ayrýldý. Birinci grup, inkarsere ancak strangüle olmamýþ olgulardan, ikinci grup ise inkarserasyona ek olarak strangüle olgulardan oluþturuldu. Ayrýca intestinal rezeksiyon gereksiniminin varlýðýna göre grup (1 veya 2)a ve grup (1 veya 2)b olmak üzere iki alt grup daha oluþturuldu.
BULGULAR: Ýnkarsere fýtýk nedeniyle acil karýn ön duvarý onarýmý yapýlan toplam 106 hasta çalýþmaya dahil edildi. Sistemik inflamasyonla ilgili indekslerin deðerlendirildiðinde strangüle hastalarda laktat dehidrojenaz/lökosit oranýnýn anlamlý olarak daha düþük olduðu, ancak nötrofil/platelet oraný ve nötrofil/albümin oranlarýnýn anlamlý olarak daha yüksek olduðu gözlendi ve bu sistemik inflamasyon indekslerinin strangülasyonu tespit etmedeki önemini gösterdi (sýrasýyla p=0.027, p=0.035 ve p=0.030). Ayrýca intestinal rezeksiyon gereken hastalar analiz edildiðinde intestinal rezeksiyon yapýlan hastalarda Nötrofil/Albümin oranýnýn anlamlý olarak daha yüksek olduðunu saptandý (p=0.036).
TARTIÞMA: Laktat dehidrojenaz/lökosit oraný, nötrofil/platelet oraný ve özellikle nötrofil/albümin oraný gibi sistemik inflamasyon indeksleri, acil fýtýk cerrahisinde komplikasyonlarý önlemek ve klinik sonuçlarý iyileþtirmek için faydalý olma potansiyeli taþýmaktadýr.