Jancelewicz et al. recently published a retrospective analysis demonstrating that CT findings of reduced wall enhancement were the most significant independent predictor of bowel strangulation, with 56% sensitivity and 94% specificity. By contrast, elevated white blood cell (WBC) count and guarding

on physical examination were only moderately predictive. It should be noted, however, that an elevated WBC was the only variable found to be independently predictive of bowel strangulation in patients with small bowel obstruction [24]. Laparoscopic approach Repair of incarcerated hernias – both ventral and groin – may be performed with https://www.selleckchem.com/products/MDV3100.html a laparoscopic approach (grade 1C recommendation). Recent prospective studies and recent guidelines [25–31] have focused on the laparoscopic learn more approach to hernia repair in an elective setting. By contrast, few studies have focused on the laparoscopic approach to hernia repair in an emergency setting. In 2004, Landau et al.

published a retrospective study investigating the use of laparoscopy in the repair of incarcerated incisional and ventral hernias. The authors argued that laparoscopic repair was feasible and could be safely used to treat patients presenting with incarcerated incisional and ventral hernias [32]. Another retrospective study published in 2008 investigated the role of laparoscopy in the management of incarcerated (non-reducible) ventral hernias. The authors concluded that laparoscopic repair of ventral abdominal wall hernias could be safely performed with low subsequent complication rates, even in the event of an incarcerated hernia. Careful bowel reduction with adhesiolysis and mesh repair in an uncontaminated abdomen (without inadvertent enterotomy) using a 5-cm mesh overlap was an important factor predictive of Demeclocycline successful clinical outcome [33]. In 2009, another retrospective study was published investigating laparoscopic techniques used to treat incisional hernias in an emergency setting. The results of this series also demonstrated the feasibility of laparoscopic surgery to treat

incarcerated incisional hernias in an emergency setting [34]. Additionally, a systematic literature review performed in 2009 identified articles reporting on laparoscopic treatment, reduction, and repair of incarcerated or strangulated inguinal hernias from 1989 to 2008. It included seven articles on this topic, reporting on 328 cases treated with total extraperitoneal (TEP) or transabdominal preperitoneal (TAPP) repair. Laparoscopy can also be used to resect bowel, if necessary, or to repair an occult contralateral hernia, present in 11.2–50% of cases. The Authors concluded that the laparoscopic repair is a feasible procedure with acceptable results; however, its efficacy needs to be studied further, ideally with larger, multicenter randomized controlled trials [35] In 2007 a series of patients with large irreducible groin hernias (omentoceles), treated by laparoscopy without conversions, was published.