Risk Factors Of Incarcerated Inguinal Hernia In Adults And Analysis Of The Efficacy Of Different Surgical Methods For Incarcerated Inguinal Hernia

Objective:To investigate the risk factors of incarcerated inguinal hernia in adults,and to compare the clinical efficacy of different surgical methods for incarcerated inguinal hernia.Materials and methods:The adult patients with inguinal hernia admitted to Lanzhou University First Hospital from January 2019 to December 2020 were retrospectively analyzed.According to the inclusion and exclusion criteria,the patients were divided into incarcerated group and non-incarcerated group.The clinical data of the patients,such as Gender,age,body mass index,history of smoking,history of diabetes,history of hypertension,history of anticoagulant use,history of radiotherapy and chemotherapy,long-term cough and constipation,ascites,recurrence,history of abdominal surgery,type of hernia and size of internal ring mouth,etc.SPSS25.0 was used for correlation statistical analysis,and statistically significant variables were subjected to multivariate Logistic regression analysis;patients with incarcerated inguinal hernia were divided into open group and endoscopic group according to different surgical methods.The time,intraoperative bleeding and secondary injury,postoperative pain,urinary retention,hospitalization expenses,and postoperative hospitalization time were recorded,followed up by telephone,and the above indicators were statistically analyzed.Results:A total of 589 adult patients with inguinal hernia were included.There were 534 patients with non-incarcerated inguinal hernia,including 482 males（90.3%）and 52 females（9.7%）.Univariate analysis found that there were 55 incarcerated inguinal hernia patients,43 males（78.2%）and 12 females.Cases（21.8%）,the gender composition of the two groups of patients was statistically different（p=0.006）.The median age of the non-incarcerated group was 64.00（52.50,71.00）years,and the median age of the incarcerated group was 67.00（53.00,81.00）years,and there was a statistical difference between the two groups（p=0.024）.The median BMI of the non-incarcerated group was 22.83（20.98,25.25）kg/m~2,and the median BMI of the incarcerated group was 21.97（20.05,24.22）kg/m~2,and there was a statistically significant difference between the two groups（p=0.040）.There were 98 cases（18.4%）and 4 cases（7.3%）in the non-incarcerated group and the incarcerated group with a history of abdominal surgery,respectively,and there was a statistically significant difference between the two groups（p=0.039）.Hernias were 8 cases（1.5%）and 8cases（14.5%）respectively,and the difference between the two groups was statistically significant（p<0.001）.The size of the inner ring in the incarcerated group was 3.00（2.00,3.00）cm,and there was a statistical difference between the two groups（p<0.001）.The incidence of incarcerated inguinal hernia in adults was not associated with smoking,hypertension,diabetes,history of anticoagulant drug use,history of radiotherapy and chemotherapy,and recurrence（p≥0.05）.The incarcerated situation was used as the dependent variable,and the statistically significant indicators（gender,age,BMI,history of abdominal surgery,ascites,hernia type,and internal ring size）were used as independent variables in univariate analysis.Among the hernia types,Femoral hernia was set as a dummy variable,and binary logistic regression analysis was performed.The results showed that ascites（OR=2.464,95%CI:1.057-5.742,p=0.037）,femoral hernia in hernia type was compared with other types of hernia（indirect hernia:OR=0.077,95%CI:0.016-0.371,p=0.001;direct hernia:OR=0.038,95%CI:0.006-0.246,p=0.001;compound hernia:OR=0.051,95%CI:0.005-0.483,p=0.009;bilateral hernia:OR=0.044,95%CI:0.007-0.255,p=0.001）and larger internal ring defect（OR=2.637,95%CI:1.773-3.921,p<0.001）yes Independent risk factors for incarcerated inguinal hernia in adults.Gender,age and BMI had no effect on incarcerated inguinal hernia in adults.Among the 55 patients with incarcerated inguinal hernia,34 patients underwent open surgery,19 patients underwent laparoscopic surgery,and 2 patients refused surgery.The intraoperative blood loss,hospital stay,intraoperative patch placement and postoperative pain were10（10,20）ml and 20（20,30）ml,3（3,5）days in the endoscopic and open groups,respectively.and 6（5,10.25）days,19 cases（44.2%）and 24 cases（55.8%）,3 cases（15.8%）and 16 cases（84.2%）,compared with the above indicators,there was a statistical difference（p<0.05）,the operation time,hospitalization cost,intraoperative side injury and postoperative urinary retention were 120（100,140）min and 120（90,200）min in the endoscopic and open groups,respectively,17231.54（11419.01,21617.93）yuan and 23323.85（9857.57,36080.01）yuan,0 cases（0%）and 3 cases（100%）,3 cases（42.9%）and 4 cases（57.1%）.There was no statistical difference in the above indicators between the two groups（p>0.05）.One patient died of pulmonary infection during hospitalization.During the follow-up period,4 elderly patients died of non-surgical factors.One patient in the endoscopic group and one in the open group developed chronic pain,and one patient in the open group developed incision infection,all of which improved after conservative treatment.No complications occurred in the remaining patients,and there was no statistical difference between the two groups of patients.Conclusion:The main risk factors for incarcerated inguinal hernia in adults are ascites,femoral hernia,and larger hernia ring defect.Laparoscopic treatment of incarcerated inguinal hernia has the advantages of high mesh placement rate,less intraoperative blood loss,shorter hospital stay and less postoperative pain,but open surgery has the advantages of local anesthesia and convenient bowel resection,so it should be Comprehensive assessment of the patient’s own situation to choose the best treatment.