Abstract：
Emergency presentations of hernias can pose significant morbidity. In addition, providing optimal surgical intervention can be challenging due to patient and disease factors with multiple treatment modalities available. Recently there have been several guidelines written to help standardize practices in hernia management. The aim of our study was to review emergency hernia operations at our tertiary level teaching hospital, the method of repair and how this matched to international guidelines.
We performed a retrospective chart review of all the patients who underwent emergency hernia surgery for strangulated/incarcerated hernias in our department over a 3-year period. Adherence to guidelines was assessed looking at appropriateness of mesh utilization, as well as the appropriateness of antibiotic usage.
A total of 184 cases from April 1st 2018 to March 31st 2021 were included. Of these hernias 12% contained necrotic or perforated bowel, 42% contained viable incarcerated bowel, and 45% contained just incarcerated fat. The compliance to the appropriate use of mesh overall was 85%, with a variation by hernia type. The global compliance to appropriate antibiotic therapy was high, at 89.7%. With antibiotic use compliance being very high in clean wounds (95.6%), and dirty wounds (100%). But lower in clean/contaminated or contaminated wounds (36.8%).
Compliance at our hospital was globally good. Areas of decreased compliance seem to be mostly regarding mesh use and antibiotic use in potentially contaminated fields and the concept of risk of bacterial translocation versus actual contamination, as well as in mesh use in smaller umbilical hernias.
We performed a retrospective chart review of all the patients who underwent emergency hernia surgery for strangulated/incarcerated hernias in our department over a 3-year period. Adherence to guidelines was assessed looking at appropriateness of mesh utilization, as well as the appropriateness of antibiotic usage.
A total of 184 cases from April 1st 2018 to March 31st 2021 were included. Of these hernias 12% contained necrotic or perforated bowel, 42% contained viable incarcerated bowel, and 45% contained just incarcerated fat. The compliance to the appropriate use of mesh overall was 85%, with a variation by hernia type. The global compliance to appropriate antibiotic therapy was high, at 89.7%. With antibiotic use compliance being very high in clean wounds (95.6%), and dirty wounds (100%). But lower in clean/contaminated or contaminated wounds (36.8%).
Compliance at our hospital was globally good. Areas of decreased compliance seem to be mostly regarding mesh use and antibiotic use in potentially contaminated fields and the concept of risk of bacterial translocation versus actual contamination, as well as in mesh use in smaller umbilical hernias.
摘要：
背景：疝气的紧急表现可能导致严重的发病率。此外,提供最佳的手术干预可能是具有挑战性的，由于患者和疾病因素与多种治疗模式可用。最近，已经编写了一些指南来帮助规范疝气管理的实践。我们研究的目的是回顾我们三级教学医院的紧急疝气手术，修复方法以及如何与国际准则相匹配。
方法：我们对在我们科室接受了3年的绞窄/嵌顿疝急诊手术的所有患者进行了回顾性分析。对指导方针的遵守情况进行了评估，考察了网格利用的适当性，以及抗生素使用的适当性。
结果：共纳入2018年4月1日至2021年3月31日的184例病例。在这些疝中，12%含有坏死或穿孔的肠，42%含有可行的肠梗阻，45%的人只含有被监禁的脂肪。遵守适当使用的网格总体上是85%，有不同类型的疝气。全球对适当抗生素治疗的依从性很高，89.7%。清洁伤口的抗生素使用依从性很高（95.6％），肮脏的伤口（100%）但较低的清洁/污染或污染的伤口（36.8％）。
结论：我们医院的依从性在全球范围内良好。依从性下降的领域似乎主要涉及潜在污染领域中的网状物使用和抗生素使用，以及细菌移位风险与实际污染的概念。以及在较小的脐疝中使用网状物。
方法：我们对在我们科室接受了3年的绞窄/嵌顿疝急诊手术的所有患者进行了回顾性分析。对指导方针的遵守情况进行了评估，考察了网格利用的适当性，以及抗生素使用的适当性。
结果：共纳入2018年4月1日至2021年3月31日的184例病例。在这些疝中，12%含有坏死或穿孔的肠，42%含有可行的肠梗阻，45%的人只含有被监禁的脂肪。遵守适当使用的网格总体上是85%，有不同类型的疝气。全球对适当抗生素治疗的依从性很高，89.7%。清洁伤口的抗生素使用依从性很高（95.6％），肮脏的伤口（100%）但较低的清洁/污染或污染的伤口（36.8％）。
结论：我们医院的依从性在全球范围内良好。依从性下降的领域似乎主要涉及潜在污染领域中的网状物使用和抗生素使用，以及细菌移位风险与实际污染的概念。以及在较小的脐疝中使用网状物。
