Iatrogenic vascular injuries in inguinal hernia repair: A comprehensive analysis of incidence, management, and outcomes

Background

Iatrogenic vascular injuries associated with inguinal herniorrhaphy are seldom documented. This study sought to provide a thorough analysis of the types, underlying mechanisms, treatment approaches, results, and mortality hazards linked to such vascular injuries during the repair of inguinal hernias.

Methods

Thirteen cases of vascular injury among 3988 inguinal hernia repair patients were retrospectively analyzed from 2012 to 2023. The data included demographic information, injury types, surgical details, patient presentations, diagnostic methods, management strategies, and outcomes. Factors contributing to mortality risk were identified via univariate analysis.

Results

The incidence of vascular injuries was 0.075 %, with 92.31 % being penetrating injuries and 7.69 % being blunt injuries. Common mechanisms included intraoperative dissections, trocar-related injuries, and mechanical mesh fixation. Treatment approaches included anastomosis, transplantation, endovascular therapy, ligation, and conservative methods. The 30-day mortality rate was 23.07 %, primarily due to hemorrhage-induced multiorgan failure. Late complications included anastomotic restenosis, graft aneurysms, testicular atrophy, and hernia recurrence.

Conclusions

Iatrogenic vascular injuries during inguinal herniorrhaphy, though rare, pose significant risks of mortality and complications. Timely identification, intervention, and long-term monitoring are vital for improving outcomes. This study offers insights into managing complex vascular challenges in hernia repair, with the goal of improving patient outcomes.