Naaga Vishnu Shankar, M (2020) A Clinical study on Complicated Hernias Presenting in Emergency Ward, Tirunelveli Medical College Hospital. Masters thesis, Tirunelveli Medical College, Tirunelveli.
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Abstract
BACKGROUND: Abdominal wall hernia are commonly encountered in surgical practice. Irreducibility, obstruction and strangulation are its commonest complications which usually presents as acute emergencies. Emergency repair of complicated hernias is associated with poor prognosis and a high rate of postoperative complications even with better care, improved anaesthetic management and advanced surgical techniques. AIM OF THE STUDY: The aim of this study was to determine the various modes of presentation, clinical finding, diagnostic and therapeutic strategies and to evaluate the postoperative outcome in complicated groin hernia surgeries in our setup. METHODS: The study was carried out among 100 patients with hernias, who had complicated clinical presentation like irreducibility, strangulation and obstruction in the department of general surgery, during the period from December 2017 to June 2019. Patients were enrolled into the study after proper consent for detailed clinical examination, investigation and subsequent treatment. The Data obtained included demographic characteristics, presentation, operative findings and outcome. The patients were followed up. After data collection, analysis was done with help of by SPSS software version 21. RESULTS: A total of 100 hernia patients with complicated presentation were evaluated during the study period. Among these cases 59 cases had inguinal hernias, 17 had umbilical hernia, 10 had paraumbilical hernia, 9 had incisional hernia and 5 had femoral hernia. Majority of the patients were in 5th and 6th decade. Complicated presentation of groin hernia was commonly seen in males (77%) than in females (23%) with male to female ratio of 3.3:1. Inguinal hernia complications were seen predominantly in males and femoral hernia complications in females. Right sided hernias were more common. Obstruction was the commonest complication seen in 62% of cases. The clinical presentation and duration of hernia varied in the study group, among which 26 patients had hernia for < 1 year, 54 patients had hernia for 1- 3 years, 20 patients had hernia for more than 3 years. Clinically 47 cases had localized groin pain, with vomiting and were associated with constipation. Clinically all patients presented with swelling, which was tender, and there was no impulse on coughing. Abdominal examinations showed abdominal distension in 24 cases. In the primary management of all complicated hernias, surgical reduction and repair accompanied by aggressive pre and postoperative care is suggested. Bowel resection and end-to-end anastomosis with repair were done in 12% of cases that had nonviable bowel. The commonest postoperative complication encountered in the study was pain (56) and scrotal seroma (30) followed by wound gaping (7). Septicaemia, multi-organ failure and death occurred in two cases. CONCLUSIONS: Complicated presentations like obstruction and strangulation are seen more in elderly and older people and delayed presentation is also responsible for an unfavourable outcome. The primary management of all incarcerated hernias is prompt surgical reduction and repair accompanied by aggressive pre and postoperative care. The mortality rate continues to be associated with advancing age and resection of necrotic bowel.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221711359 |
| Uncontrolled Keywords: | Complicated hernia, Irreducibility, Obstruction, Strangulation. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 11 Feb 2021 01:56 |
| Last Modified: | 11 Feb 2021 01:56 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/14037 |
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