Assessing hemoglobin, albumin, lymphocyte, platelet (HALP) score in predicting strangulation and resection in hernia surgery.

Abstract

Background: Incarcerated hernias carry a risk of strangulation, which can lead to bowel ischemia, necrosis, and the need for organ resection. The Hemoglobin, Albumin, Lymphocyte, Platelet (HALP) score, a composite biomarker of nutritional and inflammatory status, has shown prognostic value in various malignant and inflammatory conditions. This study aimed to evaluate the role of HALP score in predicting strangulation and the need for bowel or tissue resection in patients undergoing surgery for incarcerated abdominal wall hernias.

Methods: We retrospectively analyzed the data of 135 patients who underwent elective or emergency hernia surgery due to incarceration between 2015 and January 2025. Patients were divided into two groups: those requiring tissue or organ resection due to intraoperative signs of strangulation (n = 53) and those who underwent hernia repair without resection (n = 82). HALP scores were calculated using preoperative laboratory values. Statistical analyses were performed using non-parametric tests due to the non-normal distribution of variables. A p-value < 0.05 was considered statistically significant.

Results: Of the 135 patients included, 53 (39.3%) underwent bowel or tissue resection due to intraoperative evidence of strangulation, while 82 (60.7%) underwent hernia repair without resection. Patients in the resection group tended to be older (median age: 72 vs. 64 years, p = 0.083). The median HALP score was notably lower in the strangulation group (2.55) compared to the non-resection group (4.55), though the difference did not reach statistical significance (p = 0.092). The most frequently resected tissues were small intestine (41.5%) and omentum (35.8%). Resection was significantly associated with the presence of ischemia (p < 0.001), whereas no significant associations were found with hernia type, side, or surgical approach.

Conclusion: A decreasing trend was observed, the trend toward lower HALP scores in patients with strangulated hernias suggests a potential role for HALP as a supportive biomarker in preoperative risk assessment. Its low cost and accessibility make it a practical tool, especially in emergency settings. Larger, prospective studies with standardized preoperative protocols are warranted to validate the clinical utility of HALP in predicting ischemic complications in incarcerated hernias.