Objective  To analyze the clinical characteristics, diagnosis and treatment strategies, and surgical methods of incarcerated inguinal hernia, in order to enhance the understanding of the disease among clinicians.

Methods  The clinical data of patients with incarcerated inguinal hernia admitted to the Department of Gastrointestinal, Hernia and Abdominal Wall Surgery of Zhengzhou Central Hospital Affiliated to Zhengzhou University from June 2021 to June 2024 were retrospectively analyzed. The clinical characteristics, treatment methods, and prognosis of these patients were summarized.

Results  A total of 45 patients were included. Among them, 9 cases were successfully treated with manual reduction (including 1 case of pseudo-reduction and emergency surgery was performed), and the remaining of 36 cases underwent emergency operation due to failure of manual reduction or lack of indications for manual reduction. Among the 37 emergency surgery patients, there were 21 cases of indirect hernia, 3 cases of direct hernia (all male), 9 cases of femoral hernia (all female) and 4 cases of obturator hernia (all female). The contents of incarcerated hernia included small intestine in 34 cases, sigmoid colon in 2 cases, appendix and part of cecum in 1 case. After repositioning the contents of the hernia through laparoscopic surgery, hernia repair was performed. Based on the degree of ischemic recovery, 6 cases were converted to open surgery for intestinal resection, 3 cases were found to have strangulated necrosis and converted to open surgery for necrosis resection and hernia repair, 1 case was in critical condition and directly underwent open tissue suture repair, and retrograde incarcerated hernia (Maydl hernia) was confirmed by abdominal exploration twice, and partial small bowel resection was performed. According to the abdominal contamination, 3 patients were treated with biological mesh and 33 patients were treated with polypropylene lightweight large-mesh mesh. The operation time was 50-130 minutes, with an average of 70.5 minutes. One patient who underwent simple tissue suture repair died on the third day after surgery, the other patients were discharged smoothly, and the hospitalization time was 2 to 26 days. All patients were followed up for half a year, one year and one and a half years after operation, and there was no recurrence or mesh related infection.

Conclusion  The condition of incarcerated hernia is complex and changeable, and individualized treatment should be made according to the condition. Manual reduction can make the operation from emergency to elective. The surgical methods need to be selected based on the patients' condition. Laparoscopy has obvious advantages in all aspects. Abdominal contamination is not a contraindication for material repair. Under the conditions, tension-free repair should be prioritized, and synthetic mesh is the preferred choice. Biological mesh has more advantages when the abdominal cavity is heavily contaminated, and the material repair should be avoided when the abdominal wall soft tissue infection in the repair area is combined.

1.Kulacoglu H. Current opinions in inguinal hernia emergencies: a comprehensive review of related evidences[J]. Int J Abdom Wall Hernia Surg, 2023, 6(3): 136-158. DOI: 10.4103/ijawhs.ijawhs_30_23.

2.翁山耕, 陈易平, 刘国忠, 等. 腹股沟疝急诊手术治疗原则 [J]. 中国实用外科杂志, 2023, 43(6): 671-675. [Weng SG, Chen  YP, Liu GZ, et al. Principles of emergency surgery for inguinal hernia[J]. Chinese Journal of Practical Surgery, 2023, 43(6): 671-675.] DOI: 10.19538/j.cjps.issn1005-2208.2023.06.12.

3.李绍春, 黄磊, 蔡昭, 等. 高龄病人腹外嵌顿疝合并肠坏死的诊疗体会[J]. 外科理论与实践, 2019, 24(4): 356-358. [Li  SC, Huang L, Cai Z, et al. Diagnosis and treatment of incarcerated hernia in elderly patients with intestinal necrosis[J]. Journal of Surgery Concepts & Practice, 2019, 24(4): 356-358.] DOI: 10.16139/j.1007-9610.2019.04.016.

4.陈思梦. 急诊腹股沟疝治疗策略[J]. 中国实用外科杂志, 2017, 37(11): 1218-1223. [Chen SM. Treatment strategy of emergency inguinal hernia[J]. Chinese Journal of Practical Surgery, 2017, 37(11): 1218-1223.] DOI: 10.19538/j.cjps.issn1005-2208.2017.11.07.

5.唐健雄, 郑民华, 陈杰, 等. 腹腔镜腹股沟疝手术操作指南(2017版)[J]. 中国实用外科杂志, 2017, 37(11): 1238-1242. [Tang JX, Zheng MH, Chen J, et al. Guidelines for laparoscopic inguinal hernia surgery (2017 edition)[J]. Chinese Journal of Practical Surgery, 2017, 37(11): 1238-1242.] DOI: 10.19538/j.cjps.issn1005-2208.2017.11.13.

6.唐健雄, 李航宇, 王明刚, 等. 青年腹股沟疝诊断和治疗中国专家共识(2020版)[J]. 中国实用外科杂志, 2020, 40(7): 754-757. [Tang JX, Li HY, Wang MG, et al. Chinese expert consensus on diagnosis and treatment of youth inguinal hernia (2020)[J]. Chinese Journal of Practical Surgery, 2020, 40(7): 754-757.] DOI: 10.19538/j.cjps.issn1005-2208.2020.07.02.

7.HerniaSurge Group. International guidelines for groin hernia management[J]. Hernia, 2018, 22(1): 1-165. DOI: 10.1007/s10029-017-1668-x.

8.张辉, 李健文, 郑民华, 等. 腹腔镜腹股沟疝修补术临床安全性和有效性评价研究[J]. 中华实用诊断与治疗杂志, 2009, 23(1): 35-37. [Zhang H, Li JW, Zheng MH, et al. Evaluation of clinical safety and efficiency of laparoscopic inguinal hernia repair[J]. Journal of Chinese Practical Diagnosis and Therapy, 2009, 23(1): 35-37.] https://d.wanfangdata.com.cn/periodical/ChVQZXJpb2RpY2FsQ0hJMjAyNTA2MjISEnN5emR5emx6ejIwMDkwMTAxNBoIdGtjam5jeWI%3D

9.李绍杰, 李绍春, 苏远涛, 等. 嵌顿性腹股沟疝急诊手术术式选择及疗效分析(附单中心10年497例报告)[J]. 中国实用外科杂志, 2023, 43(6): 688-691, 696. [Li SJ, Li SC, Su YT, et al. Selection and analysis of therapeutic effects of emergency surgical procedures for incarcerated inguinal hernia (report of 497 cases in a single center over 10 years)[J]. Chinese Journal of Practical Surgery, 2023, 43(6): 688-691.] DOI: 10.19538/j.cjps.issn1005-2208.2023.06.16.

10.Nilsson H, Stylianidis G, Haapamäki M, et al. Mortality after groin hernia surgery[J]. Ann Surg, 2007, 245(4): 656-660. DOI: 10.1097/01.sla.0000251364.32698.4b.

11.Pawlak M, East B, de Beaux AC. Algorithm for management of an incarcerated inguinal hernia in the emergency settings with manual reduction. Taxis, the technique and its safety[J]. Hernia, 2021, 25(5): 1253-1258. DOI: 10.1007/s10029-021-02429-1.

12.陈孝平, 汪建平, 赵继宗. 外科学(第9版)[M]. 北京: 人民卫生出版社, 2018: 315.

13.胡星辰, 李绍杰, 唐健雄, 等. 聚丙烯补片运用于嵌顿性腹股沟疝的临床评价(附46例报告)[J]. 中华疝和腹壁外科杂志(电子版), 2017, 11(3): 171-173. [Hu XC, Li SJ, Tang JX, et al. Clinical evaluation of polypropylene patch applied to incarcerated inguinal hernia: a report of 46 cases[J]. Chinese Journal of Hernia and Abdominal Wall Surgery (Electronic Edition), 2017, 11(3): 171-173.] DOI: 10.3877/cma.j.issn.1674-392X.2017.03.004.

14.张启瑜. 钱礼腹部外科学(第2版)[M]. 北京: 人民卫生出版社, 2017: 81.

15.唐健雄, 郑民华, 李健文, 等. 嵌顿性腹股沟疝腹腔镜诊治流程中国专家共识(2024版)[J]. 中国实用外科杂志, 2024, 44(7): 721-729. [Tang JX, Zheng MH, Li JW, et al. Chinese expert consensus on laparoscopic diagnosis and treatment algorithm for incarcerated inguinal hernia (2024 Edition)[J]. Chinese Journal of Practical Surgery, 2024, 44(7): 721-729.] DOI: 10.19538/j.cjps.issn1005-2208.2024.07.01.

16.杨建军, 宋致成, 顾岩. 成年女性腹股沟疝治疗难点及关键问题[J]. 中国实用外科杂志, 2017, 37(11): 1214-1218. [Yang  JJ, Song ZC, Gu Y. Key issues and difficulties in management of female inguinal hernia[J]. Chinese Journal of Practical Surgery, 2017, 37(11): 1214-1218.] DOI: 10.19538/j.cjps.issn1005-2208.2017.11.06.

17.李健文, 李航宇, 王明刚, 等. 腹腔镜腹股沟疝手术焦点问题中国专家共识(1)——术式选择[J]. 中国实用外科杂志, 2023, 43(6): 631-645, 682. [Li JW, Li HY, Wang MG, et al. Chinese expert consensus on key issues of laparoscopic in-guinal hernia surgery (Ⅰ)-choice of surgical procedure[J]. Chinese Journal of Practical Surgery, 2023, 43(6): 631-645, 682.] DOI: 10.19538/j.cjps.issn1005-2208.2023.06.03.

18.王明刚, 李航宇. 关于老年腹股沟疝患者围手术期并发症的思考[J]. 中国普通外科杂志, 2018, 27(10): 1215-1219. [Wang MG, Li HY. Reflections on perioperative complications of inguinal hernia in elderly patients[J]. Chinese Journal of General Surgery, 2018, 27(10): 1215-1219.] DOI: 10.7659/j.issn.1005-6947.2018.10.002.

19.唐健雄, 李绍杰. 疝和腹壁外科20年发展的经验[J]. 外科理论与实践, 2021, 26(5): 373-376. [Tang JX, Li SJ. The experience of 20 years' development of hernia and abdominal wall surgery[J]. Journal of Surgery Concepts & Practice, 2021, 26(5): 373-376.] DOI: 10.16139/j.1007-9610.2021.05.001.

20.Elsebae MM, Nasr M, Said M. Tension-free repair versus Bassini technique for strangulated inguinal hernia: a controlled randomized study[J]. Int J Surg, 2008, 6(4): 302-305. DOI: 10.1016/j.ijsu.2008.04.006.

21.中华医学会外科学分会疝与腹壁外科学组, 中国医师协会外科医师分会疝和腹壁外科医师委员会. 成人腹股沟疝诊断和治疗指南(2018年版)[J]. 中国实用外科杂志, 2018, 56(7): 495-498. [Chinese Society of Hernia and Abdominal Wall Surgery, Chinese Society of Hernia and Abdominal Wall Surgery, Chinese Medical Doctor Association. Guidelines for diagnosis and treatment on the adult groin hernia (2018 edition)[J]. Chinese Journal of Surgery, 2018, 56(7): 495-498.] DOI: 10.19538/j.cjps.issn1005-2208.2018.07.02.

22.Aiolfi A, Campanelli G. Safety and feasibility of emergency robot-assisted transabdominal preperitoneal repair for the treatment of incarcerated inguinal hernia: a retrospective study[J]. World J Surg, 2024, 48(3): 629-630. DOI: 10.1002/WJS.12086.

23.Pandey H, Thakur DS, Somashekar U, et al. Use of polypropylene mesh in contaminated and dirty strangulated hernias: short-term results[J]. Hernia, 2018, 22(6): 1045-1050. DOI: 10.1007/s10029-018-1811-3.

24.魏士博, 李航宇, 李健文, 等. 腹腔镜腹股沟疝手术焦点问题中国专家共识(2)——特殊情况处理[J]. 中国实用外科杂志, 2024, 44(4): 387-391. [Wei SB, Li HY, Li JW, et al. Chinese expert consensus on key issues of laparoscopic inguinal hernia surgery (Ⅱ)-coping with special cases[J]. Chinese Journal of Practical Surgery, 2024, 44(4): 387-391.] DOI: 10.19538/j.cjps.issn1005-2208.2024.04.02.

25.Zanoni AAG, Delcarro A, Ciccarese F, et al. Laparoscopic transperitoneal hernia repair (TAPP) in emergency: long-term follow-up in a high volume centre[J]. Hernia, 2022, 26(4): 1063-1068. DOI: 10.1007/s10029-021-02516-3.

26.孙立, 陈杰, 申英末. 国产新型生物疝修补片与聚丙烯产品在腹股沟疝修补术中的疗效对比[J]. 中华疝和腹壁外科杂志(电子版), 2019, 13(2): 101-104. [Sun L, Chen J, Shen YM. Comparative study on the application of a new type of biologic mesh and polypropylene product in inguinal hernioplasty[J]. Chinese Journal of Hernia and Abdominal Wall Surgery (Electronic Edition), 2019, 13(2): 101-104.] DOI: 10.3877/cma.j.issn.1674-392X.2019.02.002.

27.张晨波, 李健文. 应用腹腔镜技术治疗腹股沟嵌顿疝争议与挑战[J]. 中国实用外科杂志, 2015, (5): 502-505. [Zhang  CB, Li JW. Controversies and challenges of laparoscopic surgery for incarcerated inguinal hernia[J]. Chinese Journal of Practical Surgery, 2015, (5): 502-505.] DOI: 10.7504/CJPS.ISSN1005-2208.2015.05.13.

28.唐健雄, 李健文, 李航宇, 等. 疝外科缝合技术与缝合材料选择中国专家共识(2018版)[J].中国实用外科杂志, 2019, 39(1): 39-45. [Tang JX, Li JW, Li HY, et al. Chinese consensus on suture technique and suture material in hernia surgery (2018 Edition)[J]. Chinese Journal of Practical Surgery, 2019, 39(1): 39-45.] DOI: 10.19538/j.cjps.issn1005-2208.2019.01.09.

29.顾岩, 田文, 王平, 等. 腹壁缺损修复与重建中国专家共识(2019版)[J]. 中国实用外科杂志, 2019, 39(2): 101-109. [Gu  Y, Tian W, Wang P, et al. Chinese expert consensus on the repair and reconstruction of abdominal wall defects (2019 edition)[J]. Chinese Journal of Practical Surgery, 2019, 39(2): 101-109.] DOI: 10.19538/j.cjps.issn1005-2208.2019.02.01.

30.孙立, 陈杰, 申英末, 等. 生物补片在腹股沟疝治疗中应用 [J]. 中国实用外科杂志, 2017, 37(11): 1223-1227. [Sun  L, Chen  J, Shen YM, et al. Application of biologic mesh in the treatment of inguinal hernia[J]. Chinese Journal of Practical Surgery, 2017, 37(11): 1223-1227.] DOI: 10.19538/j.cjps.issn1005-2208.2017.11.08.

31.Birindelli A, Sartelli M, Di Saverio S, et al. 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias[J]. World J Emerg Surg, 2017, 12: 37. DOI: 10.1186/s13017-017-0149-y.

32.De Simone B, Birindelli A, Ansaloni L, et al. Emergency repair of complicated abdominal wall hernias: WSES guidelines[J]. Hernia, 2020, 24(2): 359-368. DOI: 10.1007/s10029-019-02021-8.

33.徐滔, 刘子文. 生物补片在青少年腹股沟疝的应用[J]. 中华疝和腹壁外科杂志(电子版), 2020, 14(1): 1-4. [Xu T, Liu ZW. Application of biological mesh in adolescent inguinal hernia[J]. Chinese Journal of Hernia and Abdominal Wall Surgery (Electronic Edition), 2020, (1): 1-4.] DOI: 10.3877/cma.j.issn.1674-392X.2020.01.001.