Emergency hernia repairs in elderly patients

Emergency hernia repairs comprise one of the most common procedures performed in elderly patients and also carry a high risk of mortality and morbidity. The aim of this study was to examine the factors that might have an influence on the outcome of emergency hernia repairs in elderly patients.

A review was made of 189 (120 male and 69 female) patients aged more than 65 years who underwent emergency hernia repair between December 1996 and January 2001 at the surgical emergency unit of our hospital. The patients' ages ranged from 65 to 100 years (mean 72.1). Concomitant diseases were present in 86 (45.5%) patients. Of 189 incarcerated hernias, there were 145 (76.7%) bowel obstructions and 91(48%) strangulations. Necrotic bowel was resected in 36(19%) patients.

While overall mortality was 5%, it was found to be 19.4% after bowel resection. Major complications were observed in 48 (25%) patients. Mortality and morbidity were clearly linked with bowel resection. Coexisting cardiopulmonary diseases, misdiagnosis, American Society of Anesthesiologists class, and late admission were also found to be responsible for unfavorable outcomes.

In elderly patients with external hernias early elective surgery should be preferred, and local anesthesia might be the best in order to avoid the increased risks of emergency hernia repairs.