Stranguluojama hernija: ar sumažintis laikas, kaip naujodantis veiksniui, sumažia intenzinio nekrozės pajėgumą?

Background: Surgical correction of abdominal wall hernias are one of the most common type of surgical procedures performed today. Being able to assess severity of a strangulated hernia in the acute setting would help the physicians and staff to easily triage and prioritize patients in greater need of emergent care. By handling the patients correctly and tending to their needs, complications such as intestinal necrosis and resection can be avoided and postsurgical complications could be minimized. The morbidity following a surgical procedure does not only bring with it a social burden but also a financial burden for the patient and the caregiver. Optimizing the care for patients with strangulated hernia will benefit all involved. There have been many case studies on hernias but so far, few authors have tried to tackle how to better manage patients with incarcerated hernia by retrospectively analyzing for time management and blood parameters that could prove useful in assessing severity of irreversible ischemic damage of the incarcerated content. Aim: The aim of this retrospective study was to collect and analyze data from Kaunas University Hospital, which is a class one hospital in the Kaunas region of Lithuania, that could prove useful in correctly assessing severity of the strangulated hernias to better prioritize patient care and thereby decreasing risk of postoperative morbidity and mortality. Objectives: 1. To analyse which time period influences the occurrence of intestinal necrosis the most. 2. To determine a cut-off value linking duration of symptoms to when intestinal necrosis is more likely. 3. To identify the criteria’s and biomarkers which could predict the risk of intestinal necrosis occurrence for patients with strangulated hernia. Method: Patient data was collected from the Department of Surgery of Hospital of Lithuanian University of Health Sciences between years 2010 – 2016. The sample size of this study was 151 patients: 66 males (43.7%) and 85 females (56.3%) Results and conclusions: We discovered that duration of symptoms is the most important variable having the highest influence on the risk of development of intestinal necrosis. Duration of >12hour in combination with age >70 and increased inflammatory biomarkers, especially LDH acts as main predictive factor for development of necrosis and need for bowel resection. Once patient presented at the emergency room there seemed to be no delay that influenced the risk of necrosi