Emergency inguinal hernia surgery: a proposed update to the clinical guidelines algorithm

Rodrigues Gonçalves, Victor; Verdaguer-Tremolosa, Mireia; Bravo-Salva, Alejandro; Martínez-López, Pilar; Pereira Rodríguez, José Antonio; López Cano, Manuel

doi:http://dx.doi.org/10.1016/j.ciresp.2025.800098

Emergency inguinal hernia surgery: a proposed update to the clinical guidelines algorithm

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Rodrigues-Gonçalves V, Verdaguer-Tremolosa M, Bravo-Salva A, Martínez-López P, Pereira-Rodríguez JA, López-Cano M. Emergency inguinal hernia surgery: a proposed update to the clinical guidelines algorithm. Cir Esp (Engl Ed). 2025 Jun;103(6):800098.. DOI: 10.1016/j.ciresp.2025.800098

Abstract

Introduction: Management strategies for acute irreducible hernias vary, with recent debates on the role of manual reduction versus immediate surgery. This study aimed to identify preoperative risk factors for bowel resection in acute irreducible inguinal hernias. Methods: A retrospective cohort study included patients from 2 university hospitals who underwent emergency surgery for acute irreducible hernias between January 2010 and December 2018. Results: Out of a total of 652 patients, 15% required intestinal resection; females, older individuals, and those with comorbidities were more likely to undergo resection. Multivariate analysis identified patients with femoral hernia (OR 2.272; 95%CI 1.275-4.047; P = .005) and preoperative intestinal obstruction (OR 8.071; 95%CI 4.331-15.043; P < .001). Patients needing resection experienced higher postoperative complication rates and longer hospital stays. Discussion: Femoral hernia and preoperative intestinal obstruction were independent predictors of bowel resection in acute irreducible hernias. Incorporating these factors into decision-making algorithms may improve patient outcomes and optimize surgical management.