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Femoral hernia: is a conservative policy justified?
1Department of Surgery, Saint Elisabeth Hospital, Tilburg, The Netherlands.
Objective:
To find out the incidence of complications among patients who present with femoral hernias and whether they are preventable.
Design:
Retrospective study.
Setting:
Teaching hospital, The Netherlands.
Subjects:
111 patients whose femoral hernias were operated on between 1 January 1983 and 31 June 1994.
Interventions:
Emergency (n = 33) and elective repair (n = 78).
Main Outcome Measures:
Morbidity and mortality, and associated factors.
Results:
Patients who underwent emergency repair were significantly older (median age 77 years, range 28-106 compared with 54, range 19-85, p < 0.001), were more likely to have cardiopulmonary disease (14/33 compared with 6/78, p < 0.001), and were more likely to need a bowel resection (9/33 compared with 0/78, p < 0.001). Three patients died in the emergency group compared with none in the elective group.
Conclusion:
An initial conservative policy led to higher subsequent morbidity and mortality because of the relatively high incidence of strangulation in older patients and those with cardiopulmonary disease. We therefore recommend elective repair as the treatment of choice.