An observational study of clinical presentation and emergency surgical management of obstructed inguinal hernia repair


  • Parag H. Godhani Department of General Surgery, Surat Municipal Institute of Medical Educaton and Research, Surat, Gujarat, India
  • Jenish V. Modi Department of General Surgery, Surat Municipal Institute of Medical Educaton and Research, Surat, Gujarat, India



Obstructed inguinal hernia, Strangulated hernia, Incarcerated hernia


Background: Inguinal hernias, one of the most causes of surgical admissions and referral of patients from primary physicians. Hernia is defined as protrusion of whole or a part of viscus through the wall that contains it. Strangulated hernia (irreducibility+obstruction+arrest of blood supply) is defined as a hernia in which blood supply of herniated viscus is constricted so much by swelling and congestion that it causes the arrest of its circulation.

Methods: The study carried out in 50 patients between August 2019 to December 2022 including patients having obstructed inguinal hernia presenting as emergencies/irreducible. Patients with obstructed hernia required emergency exploration through inguinal incision where on the basis of intraoperative presence of toxic fluid, mesh placement was decided.

Results: Total 50 patients were studied with the highest incidence at age 61-75, the most common site of obstruction was internal inguinal ring (n=42), most commonly presenting with symptoms of pain (n=50), swelling (n=50) followed by vomiting (n=29).

Conclusions: The right sided hernia was more commonly involved in obstruction at the level of the internal inguinal ring followed by superficial ring and mesh was kept according to the presence of toxic fluid. The most common procedure was posterior wall repair (n=31) with or without resection and anastomosis followed by meshplasty (n=19) where the complication were less observed with meshplasty (n=3) and highest complication were observed in posterior wall repair (n=9) with or without resection and anastomosis.


Nicholson S. Inguinal hernia repair. Br J Surg. 1999;86(5):577-8.

Jenkins JT, O’Dwyer PJ. Inguinal hernia. BMJ. 2008;336(7638):269-72.

Skandalakis LJ, GadaczTR, Mansberger AR, Mitchell WE, Colborn GL. Prosthetic mesh repair for incarcerated inguinal hernia. Modern Herni Tamiri. 2002;1:3-250.

Lichtenstein IL, Shore JM. Simplified repair of femoral and recurrent inguinal hernia by a “plug” Technique. Arm J Surg. 1974;128:439-56.

Velitchkov NG, Losanoff JE, Kiossev KT, Grigorov GI, Kirov GK, Losanoff CE. The Lichtenstein open tension-free inguinal hernia repair using a new prosthetic mesh- Bulgarian irresorbable ampoxen. Int Surg. 1996;81:205-9.

Nieuwenhuizen J, van Ramshorst GH, ten Brinke JG, de Wit T, van der Harst E, Hop WC, et al. The use of mesh in acute hernia: frequency and outcome in 99 cases. Hernia. 2011;15(3):297.

Rantomalala HY, Andriamanarivo ML, Rasolonjatovo TY, Rakotoarisoa AJ, Rakotoarisoa B, Razafindramboa H, et al. Children’s strangulated inguinal hernia. Arch Pediatr. 2005;12(3):361-5.

Ihedioha U, Alani A, Modak P, Chong P, O’Dwyer PJ. Hernias are the most common cause of strangulation in patients presenting with small bowel obstruction. Hernia. 2006;10(4):338-40.

Alvarez JA, Baldonedo RF, Bear IG, Sol´ıs JA, Alvarez P, Jorge JI. Incarcerated groin hernias in adults: presentation and outcome. Hernia. 2004;8(2):121-6.

Derici H, Unalp HR, Bozdag AD, Nazli O, Tansug T, Kamer E. Factors affecting morbidity and mortality in incarcerated abdominal wall hernias. Hernia. 2007;11(4):341-6.

Hernia Surge Group. International guidelines for groin hernia management. Hernia. 2018;22(1):1-165.

Sarosi GA, Wei Y, Gibbs JO, Reda DJ, McCarthy M, Fitzgibbons RJ, et al. A clinician's guide to patient selection for watchful waiting management of inguinal hernia. Ann Surg. 2011;253(3):605-10.

Wong PF, Gilliam AD, Kumar S, Shenfine J, O'Dair GN, Leaper DJ. Antibiotic regimens for secondary peritonitis of gastrointestinal origin in adults. Cochrane Database Syst Rev. 2005;(2):004539.

Papaziogas B, Lazaridis C, Makris J, Koutelidakis J, Patsas A, Grigoriou M, et al. Tension-free repair versus modified Bassini technique (Andrews technique) for strangulated inguinal hernia: a comparative study. Hernia. 2005;9:156-9.

Bessa SS, Katri KM, Salam WN, Abdel-Baki NA. Early results from the use of the Lichtenstein repair in the management of strangulated groin hernia. Hernia. 2007;11:239-42.

Kurt N, Oncel M, Ozkan Z, Bingul S. Risk and outcome of bowel resection in patients with incarcerated groin hernias: retrospective study. World J Surg. 2003;27(6):741-3.

Padmasree G. A clinical study on obstructed inguinal hernia: a descriptive study on 53 cases. Int Surg J. 2019;6:1965-71.

Shakya VC, Agrawal CS, Adhikary S. A prospective study on clinical outcome of complicated external hernias. Health Renaissance. 2012;10(1):20-6.

Derici H, Unalp HR, Nazil O, Kamer E, Coskun M, Tansug T, et al. Prosthetic repair of incarcerated inguinal hernias: is it a reliable method? Langenbecks Arch Surg. 2010;395(5):575-9.

Sawayama H, Kanemitsu K, Okuma T, Inoue K. Safety of polypropylene mesh for incarcerated groin and obturator hernias: a retrospective study of 110 patients. Hernia. 2014;18(3):399-406.

Dai W, Chen Z, Zuo J, Tan J, Yuan Y. Risk factors of postoperative complications after emergency repair of incarcerated groin hernia for adult patients: a retrospective cohort study. Hernia. 2019;23:267-76.

Bessa SS, Abdel-fattah MR. Results of prosthetic mesh repair in the emergency management of the acutely incarcerated and/or strangulated groin hernias: a 10-year study. Hernia. 2015;19(6):909-14.

Sorour MA. Interposition of the omentum and/or the peritoneum in the emergency repair of large ventral hernias with polypropylene mesh. Int J Surg. 2014;12(6):578-86.

Adesunkanmi ARK, Agbakwuru EA, Badmus TA. Obstructed abdominal hernia at the Wesley Guild Hospital, Nigeria. East Afr Med J. 2000;73:727-31.

Archampong EQ, Naaeder SB, Darko R. Changing pattern of intestinal obstruction in Accra, Ghana. Hepatogastroenterol. 2000;43:34-6.

Ngim OE, Udosen J, Essiet A, Efem SEE, Bassey OO. Acute intestinal obstruction from post-operative adhesions in a tertiary health facility, South, Nigeria: A one-year prospective study. IOSR J Dent Med Sci. 2013;3:44-8.

Bushra E, Doumi A, Mohammed MI. Acute Abdomen at El Obeid Hospital, Western Sudan. Sudan J Med Sci. 2008;3:191-6.

Andrew NJ. Presentation and outcome of strangulated external hernias in a District General Hospital. Br Jr Surg. 1981;68:329-2.

Hernández-Irizarry R, Zendejas B, Ramirez T. Trends in emergent inguinal hernia surgery in Olmsted County, MN: a population-based study. Hernia. 2012;16(4):397-403.

Hancock BD. Strangulated hernias in Uganda and Manchester. J R Coll Surg Edinb. 1975;2:134-7.

McEntee G, Pender D, Mulvin D, McCullough M, Naeeder S, Farah S, et al. Current spectrum of intestinal obstruction. Br J Surg. 1987;74(11):976-80.

Burcharth J. The epidemiology and risk factors for recurrence after inguinal hernia surgery. Dan Med J. 2014;61:4846.

Ooe Y, Horikawa N, Miyanaga S. Management of an obstructed recurrent inguinal hernia using a hybrid method: a case report. BMC Surg. 2021;21:48.

Eze JC. Obstructed inguinal hernia: role of technical aid program. J National Med Assoc. 2004;96:6.

Bekoe S. Prospective analysis of management of incarcerated and strangulated inguinal hernia. Am J Surg. 1973;126:665-8.

Amos R, Koontz MD. Femoral hernia: operative cases at the John Hopkins Hospital during a twentyone year period. AMA Arch Surg. 1952;64:298-306.

Hentati H, Dougaz W, Dziri C. Mesh repair versus nonmesh repair for strangulated inguinal hernia: systematic review with meta-analysis. World J Surg. 2014;38:2784-90.

Wysocki A, Strzalka M, Migaczewski M, Budzynski P. Short- and long-term outcomes of incarcerated inguinal hernias repaired by Lichtenstein technique. Wideochir Inne Tech Maloinwazyjne. 2014;9:196-200.

Dunne JR, Malone DL, Tracy JK, Napolitano LM. Abdominal wall hernias: risk factors for infection and resource utilization. J Surg Res. 2003;111(1):78-84.

Azari Y, Perry Z, Kirstein B. Strangulated groin hernia in octogenarians. Hernia. 2015;19:443-7.






Original Research Articles