Incarcerated hernia: to reduce or not to reduce?

Before the advent of general anesthesia, taxis (hernia reduction) was the treatment of choice of incarcerated hernia but, over the years, its use subsided in favor of urgent herniorrhaphy. The role of taxis for incarcerated hernias in a growing geriatric population must be reexamined.

We attempted taxis in 101 adult patients diagnosed with anterior abdominal wall incarcerated hernia. Following successful taxis, patients were hospitalized for a 24-h period of observation to obviate any complications of taxis. Upon their discharge, the patients were advised to follow with an elective hernia repair. Unsuccessful attempts at taxis were followed by emergency surgery. The gender of the patient, type of hernia, time lapse since incarceration, and signs of intestinal occlusion were recorded and mortality and morbidity rates were calculated.

Taxis was successful in 60.3% of cases. No taxis-related complication was observed, even though the mean delay in presentation since incarceration was 12 h. Mortality and morbidity within the taxis group were null.

Taxis is a feasible and safe maneuver pending an eventual surgical treatment. By offering better conditions at a later repair, the mortality and morbidity may be considerably lowered. Further studies are needed in order to elucidate various aspects of this two-stage treatment of incarcerated hernia.