Strangulated inguinal hernia

Background: Strangulated inguinal hernia (SIH) has an overall prevalence of 1.3% in adults, affecting mainly senile patients, with a high incidence of morbidity and mortality. There are more than 13 different surgical techniques for treatment, but none has proven to be more effective than the others. Methods: The present observational, longitudinal and prospective study carried out at Hospital General, Centro Medico La Raza in Mexico City proposes a new surgical technique to treat SIH. Between December 2000 and August 2010, 43 adult patients with SIH were consecutively subjected to preperitoneal mesh repair and exploratory laparotomy (PPMR and ELAP), a personal modification by the author to the Stoppa-Rives technique. Several variables were studied. Results: There was zero mortality. There were no cases of inguinal recurrence or reintervention. One patient developed a granuloma at the surgical site. There were three cases of superficial wound infection, six cases of inguinoscrotal seroma, and one case of incisional hernia. Discussion: There is no international consensus on the treatment of SIH although it is interesting to analyze the studies published during the last two decades and to observe the results. Studies that propose a preperitoneal approach with mesh demonstrate the best results by reducing morbidity and mortality. Conclusions: Preperitoneal mesh repair and exploratory laparotomy reduce the rate of morbidity and mortality in the treatment of SIH. Inguinal hernias must be repaired at the time of diagnosis to avoid strangulation.