O35 WHAT HAPPENS TO PATIENTS WITH ACUTELY SYMPTOMATIC HERNIA IN THE UK? FINDINGS FROM THE MASH STUDY

Aim Acutely symptomatic abdominal wall and groin hernias (ASH) are a common reason for acute surgical admissions in the UK. There is limited data to guide the treatment of such presentations. This study aimed to assess outcomes of emergency hernia surgery, and identify common management strategies, to improve care for these high-risk patients. Material and Methods A 12 week, UK-based, multi-centre, collaborative, prospective cohort study (NCT04197271) recruited adults with ASH. Data on patient characteristics, inpatient management, quality of life, complications and wound healing was collected. 30 and 90-day follow-up phone calls assessed complications and quality of life. Descriptive analyses were performed to describe population and outcomes. Results Twenty-three acute Trusts recruited 268 patients. Inguinal (37.7%) and umbilical (37.7%) were the most common hernia locations. 13.4% were awaiting elective surgery and 13.1% had been previously declined intervention. CT was performed in 48%. 82% underwent surgical management with open repair (94%) under general anaesthesia (93%) being most common. 4/11 laparoscopic procedures were converted to open. 55% of repairs used mesh, typically synthetic non-absorbable (87%). Complications were infrequent with surgical site infection (9.4%), delirium (3.2%) and pneumonia (2.3%) being most common. Mortality was 1.5%. Immediate surgical management was associated with significant improvement in quality of life at 30 days. Conclusions There is variation in the investigation, management and surgical strategy to treat acutely symptomatic abdominal wall and groin hernias in the UK. Further large-scale work is needed to establish the optimal management strategy for specific acute presentations given the wide variation at present.

SP3.2.7 Surgical techniques in emergency hernia repair - what are we doing? Findings from the MASH study

Aims There is limited evidence to guide the emergency management of acutely symptomatic abdominal wall and groin hernias (ASH) and there is a lack of consensus on optimal surgical technique. This study aimed to explore surgical techniques used to repair ASH. Methods A prospective 12-week cohort study (NCT04197271) recruited adult patients with ASH across 23 UK sites. Baseline characteristics, quality of life, management strategy and 30/90-day outcomes were collected. For those undergoing surgery, detailed information was recorded on: time to surgery, anaesthetic technique, grade of surgeon, intraoperative findings, antibiotic use, operative approach, repair technique (mesh vs suture), mesh/suture type and position and whether bowel resection/stoma formation was required. Results Of the 264 patients recruited, 214 (82%) underwent acute repair within 48 hours of admission. 95% underwent open repair, with 93% under general anaesthetic. 5% of inguinal and femoral hernias had laparoscopic repair. Mesh was used in 89% of inguinal hernias vs 29% of umbilical hernias. The majority (86%) used a synthetic non-absorbable mesh (94% inguinal, 84% umbilical). Mesh placement varied widely for epigastric and umbilical hernia, with onlay used most commonly (24%). Similar variation was seen in suture choice. 8% developed an SSI by 30 days, the majority of which were in umbilical repairs. One patient developed early hernia recurrence (umbilical) requiring surgery. Conclusions This data demonstrates variation in the surgical management of ASH, especially with the use of mesh. Laparoscopic surgery was uncommon. Further studies are required to clarify optimal technique strategies in the emergency setting.

SP3.2.15 Patient demographics and outcomes following emergency presentation with a groin hernia; a 15-year retrospective cohort study from the North of England

Aims Over 70,000 groin hernia repairs are performed in the UK annually. While most are performed in day-case settings, emergency presentation remains common and has a high associated morbidity and mortality. This study aims to report on patient demographics and outcomes following emergency presentation with a groin hernia. Methods Data was collected for all patients >18 years admitted acutely with an inguinal or femoral hernia to NHS trusts between 2002-2016 in the North of England. This included patient demographics and operative interventions. Outcomes of interest were thirty-day inpatient mortality and length of stay (LoS). Results Overall, 6165 patients presented as an emergency with a groin hernia (76.2% inguinal) over the 15-year study period. There was a male preponderance (n = 4469, 72.5%) with a median age of 73 years (IQR: 58,82). No changes in the distribution of age or gender were noted over the study period. Comorbidity, as measured by Charlson score, increased over time (p < 0.001). Median LoS was 2 days (IQR: 1,5), increasing with age and comorbidity (both p < 0.001). Emergency surgery was performed for 3904 patients (63.3%). The thirty-day mortality rate of 3.1% rose to 3.7% in the subgroup of patients undergoing operative repair and 5.6% in those with associated bowel obstruction. Greater comorbidity and advanced age were again associated with increased mortality (both p < 0.001). Conclusions This study highlights changing patient demographics more comorbid patients presenting acutely with groin hernias. These patients must be counselled regarding their increased mortality risk as part of the shared decision-making process.

1601 Trends in Investigation, Management and Patient Outcomes Following Emergency Presentation with Groin Hernia

Aim Groin hernias are associated with an increased morbidity and mortality following emergency presentations. This study aimed to review current practices regarding investigation and operative management of acute admissions of groin hernias in the North of England. Method Patients ≥18 years admitted as an emergency with femoral or inguinal hernias, between 2002-2016, across NHS trusts in the North of England were included. Data on demographics, investigations and operative interventions was collected. Outcomes of interest included rate of bowel resection, length of stay (LoS) and 30-day postoperative mortality. Results A total of 6165 patients were identified over 15 years: 4698 inguinal hernias and 1467 femoral hernias. 3904 (63.3%) underwent emergency surgery. Pre-operative CT scanning increased from 1.0% (2002-2006) to 12.3% (2012-2016) (p < 0.001) and was associated with a reduced rate of surgical intervention (64.0% vs. 55.3%, p < 0.001). Bowel resection was higher amongst patients who underwent CT (16.6% vs. 6.4%, p < 0.001). Of those presenting with bowel obstruction, 11.7% required resection, 95.9% of these being small bowel. Bowel resection was associated with increased LoS (p < 0.001) and 30-day postoperative mortality (16.4% vs. 2.8%, p < 0.001). Laparoscopic repair, utilised in 177 procedures (4.5%), was associated with a shorter LoS compared to open repair (4.7 vs 5.5 days, p < 0.001) but no difference in mortality. Conclusions Emergency hernia repair, particularly cases requiring bowel resection, have high mortality rates. Pre-operative CT scanning is associated with reduced rates of operative intervention. Further research is required to assess the impact these changes have on surgical decision-making, and subsequent patient outcomes.

Prise En Charge Des Hernies De L’aine Au Chu-Kara (Togo)

Objectif: Evaluer la prévalence de la hernie de l’aine et d’analyser sa prise en charge au CHU-Kara (Togo). Matériel et Méthode: Il s’est agi d’une étude rétrospective et descriptive qui a été menée du 1er juillet 2014 au 31 décembre 2019 soit 66 mois au CHU Kara. Ont été inclus dans notre étude tous les patients âgés de plus de 15 ans présentant une hernie de l’aine compliquée ou non et ayant été pris en charge pendant la période d’étude. Les patients de moins de 15 ans présentant hernie de l’aine ou les autres formes de hernie de la paroi abdominale ont été exclus de notre étude. Résultats: Au cours de notre période d’étude nous avions opéré 444 hernies de l’aine dont 26 bilatérales sur les 2557 interventions réalisées en chirurgie générale. Parmi les patients opérés de hernie, 371 étaient des hommes et 60 des femmes avec une sex-ratio de 6,1.L’âge moyen était de 48 ans ±17,2.Toutes les professions étaient représentées dominées par les cultivateurs suivies des femmes au foyer. Après examen clinique les formes inguinales et inguino-scrotales prédominaient avec respectivement 60,8% et 37,6%. Parmi ces hernies de l’aine colligées 82 (18,5%) étaient étranglées et 6(1,4%) cas de récidives. Au plan thérapeutique, tous les patients avaient été opérés sous anesthésie loco-régionale. Les techniques opératoires utilisées étaient celle du Bassini dans 355 cas, le Shouldice dans 53 cas, le Lichtenstein dans 26 cas et le Mac Vay dans 10 cas. La durée moyenne du séjour était de 3,7 jours ±4,2. La morbidité a été de 6,5% dominée essentiellement par les hématomes de bourses et les suppurations pariétales. La mortalité est de 0,5%. Conclusion: La hernie de l’aine est très fréquente dans notre pratique. La hernie inguinale est la forme la plus rencontrée. Elle pose le problème de sa prise en charge dans les pays à ressources limitées. Une prise en charge précoce et efficiente permettra de réduire la morbi-mortalité dans nos pays pauvres. Objective: To assess the prevalence of groin hernia and to analyze its management at Kara Teaching Hospital, Togo. Materials and Method: This was a retrospective and descriptive study that was carried out from July 1, 2014, to December 31, 2019, i.e., 66 months at the Kara Teaching Hospital. All patients over 15 years of age with a complicated or uncomplicated groin hernia who were treated during the study period were included in our study. Patients under 15 years of age with a groin hernia or other forms of abdominal wall hernia were excluded from our study. Results: During our study period, we operated on 444 groin hernias, including 26 bilateral out of the 2557 procedures performed in general surgery. Among the hernia operated patients, 371 were men and 60 were women with a sex ratio of 6.1. The mean age was 48 ± 17.2. All professions were represented dominated by farmers followed by housewives. After clinical examination, the anatomo-clinical varieties found were dominated by inguinal forms (60.8%), followed by inguino-scrotal forms (37.6 %). Among collected groin hernias, 82(18.5%) were strangulated alongside with 6(1.4%) cases of recurrence. Therapeutically, all the patients had been operated on under locoregional anesthesia. All patients had undergone hernia repair by laparotomy. The surgical technique used was that of Bassini in 355 cases, Shouldice in 53 cases, Lichtenstein in 26 cases, and Mac Vay in 10 cases. The associated pathologies were taken care of at the same operating time. The mean length of stay was 3.7 days ± 4.2. Morbidity was 6.5%, which is mainly dominated by bursa hematomas and parietal suppurations. Mortality was 0.5%. Conclusion: Groin hernias are very common in our practice. The inguinal hernia is the most common form. Some countries lack adequate resources to effectively treat groin hernia. Early and efficient treatment will reduce morbidity and mortality in poor countries.

Laparoscopic transabdominal preperitoneal repair of concurrent spigelian and groin hernias: a rare case

Spigelian hernia is a rare type of abdominal wall hernia due to congenital defect in the transversus aponeurosis fascia. It has a prevalence of 2%. Traditionally, an anterior hernioplasty was used to repair these defects. Only a few cases have been reported in the literature. Here we discuss a case of a 66 year old female with chronic lower abdominal pain with swelling in left inguinal area diagnosed with spigelian hernia on ct scan along with left direct hernia as well as left femoral hernia found incidentally and repaired using totally extra peritoneal single mesh repair.

PATHOHISTOLOGICAL PRERECONDITIONS FOR DEVELOPMENT OF COMPLICATIONS AND R ECURRENCES I N INGUINAL HERNIOPLASTY

Summary. Inguinal hernioplasty is the most frequently performed surgical operation in the world, but the level of complications still reaches 11 % and of recurrences — 5 %. According to some authors, the reason may be in chronic inflammatory changes of the hernia sac and perihernial tissues. Aim. To study the pathohistological changes of the hernia sac and perihernial tissues of patients with inguinal hernias for development of adequate methods of complications prophylactics. Material and methods. The pathohistological examination of fragments of hernial sac and perihernial tissues of 24 patients with groin hernias was performed. Results and discussion. The investigation detected the signs of chronic inflammation in fragments of tissue of hernial sac in all patients. In 8 (33,3 %) patients the signs of inflammation were found only in fragments of hernial sac, and in 16 (66,7 %) – they were combined with the inflammation of perihernial tissues. Among them, the pronounced signs of chronic inflammation were found in 6 (25,0 %) patients with recurrent groin hernias, they were combined with the pronounced scarring changes of hernial sac and perihernial tissues. Conclusions. 1. Chronic inflammatory changes of the hernia sac and perihernial tissues are among the reasons for the development of postoperative complications and recurrences. 2. An important component of prevention of complications can be use of antibacterial and anti-inflammatory drugs.