Yichen Liu, Hiba Al-Khaffaji, Huarui Xue, Wen Yuan Chung, Hassan Nassar, Saman Habib, Molly Castagna, James Wolff
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引用次数: 0
Abstract
Purpose: Hernias are a frequent cause of acute surgical admission, yet optimal management remains uncertain. Watchful waiting (WW) and waiting-list delays may increase symptom recurrence and surgical crossover, creating uncertainty about when timely elective repair is indicated. This study evaluates acute hernia presentations and how different management pathways may influence outcomes.
Methods: A retrospective cohort study was conducted on 105 patients presenting with symptomatic hernias to the University Hospitals of Leicester from period of September 2024 to January 2025 with patient follow-up in September 2025. Outcomes analysed included length of hospital stay, complications, surgical crossover rates, and re-presentations.
Results: A total of 105 patients met the inclusion criteria. 51(49%) patients were conservatively managed with WW, and 43(41%) listed for elective repair, and 11(10%) underwent emergency surgery at presentation. WW patients had higher re-presentation rates (35.3 vs. 14%, p = 0.0172) and surgical crossover rates (33.3 vs. 2.3%, p < 0.001) relative to those awaiting elective surgery. In the WW cohort, crossover occurred in 50% of inguinal hernias (9.1% to emergency; 40.9% to elective) and approximately 20.7% of ventral hernias (10.3% to emergency; 10.3% to elective). Emergency hernia repair was associated with increased length of stay compared to elective repair for both ventral (median 4 vs. 0.5 days, p = 0.0079) and inguinal hernias (median 1.5 vs. 0 days, p < 0.001).
Conclusion: Observed surgical crossover and re-presentation among patients managed with watchful waiting may indicate the importance of identifying patients who are less suitable for prolonged non-operative management. Structured follow-up and reassessment may improve watchful waiting pathways and support shared decision-making regarding the appropriateness of surgical repair. Further studies are needed to validate these findings.
目的：疝气是急性外科住院的常见原因，但最佳处理方法仍不确定。观察等待（WW）和等待名单延迟可能增加症状复发和手术交叉，造成不确定何时需要及时选择修复。本研究评估急性疝的表现和不同的治疗途径如何影响结果。方法：对2024年9月至2025年1月在莱斯特大学医院就诊的105例有症状疝患者进行回顾性队列研究，并于2025年9月对患者进行随访。结果分析包括住院时间、并发症、手术交叉率和再诊。结果：105例患者符合纳入标准。51例（49%）患者采用WW保守治疗，43例（41%）患者选择选择性修复，11例（10%）患者在就诊时接受了紧急手术。WW患者有较高的再表现率（35.3 vs. 14%, p = 0.0172）和手术交叉率（33.3 vs. 2.3%, p）。结论：观察等待治疗的患者中观察到的手术交叉和再表现可能表明识别不适合长期非手术治疗的患者的重要性。有组织的随访和重新评估可以改善观察等待路径，并支持关于手术修复的适当性的共同决策。需要进一步的研究来验证这些发现。
期刊介绍：
Langenbeck''s Archives of Surgery aims to publish the best results in the field of clinical surgery and basic surgical research. The main focus is on providing the highest level of clinical research and clinically relevant basic research. The journal, published exclusively in English, will provide an international discussion forum for the controlled results of clinical surgery. The majority of published contributions will be original articles reporting on clinical data from general and visceral surgery, while endocrine surgery will also be covered. Papers on basic surgical principles from the fields of traumatology, vascular and thoracic surgery are also welcome. Evidence-based medicine is an important criterion for the acceptance of papers.
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