Abstract
Background Incarcerated hernia is a common surgical emergency with considerable morbidity or
even mortality. Manual reduction (taxis) and elective surgery could be an alternative
management approach. This study examines the role of taxis with the adjuvant use of
the visual analogue scale (VAS) score in treating incarcerated hernias and thereby
decreasing the emergency surgery rate, especially during the novel coronavirus disease
2019 (COVID-19) pandemic.
Methods All adult patients admitted to the emergency department of our hospital with incarcerated
hernias of anterior abdominal wall were prospectively submitted to hernia manual reduction.
The VAS score was used as an adjuvant tool for monitoring the success of this maneuver.
Patients with successful taxis and low VAS score were hospitalized for a 24-hour period
of observation. On their discharge, they were scheduled for an elective hernia repair.
Patients with unsuccessful taxis or with less than a 50% reduction in VAS score after
successful taxis were submitted to emergency surgical repair. Age, sex, type of hernias,
time until taxis, VAS scores before and after taxis, length of hospital stay, and
adverse events for both groups were recorded.
Results Between September 2018 and September 2020, 86 patients with incarcerated hernias
were included. The types of hernias were incisional in 8 patients, umbilical in 15
patients, inguinal in 56 patients, and femoral in 7 patients. Taxis was successful
in 66% of patients with a mean reduction in VAS score from 83 to 17 mm. Following
successful taxis, patients were hospitalized for a 24-hour period of observation.
No taxis-related complications were observed. Fifty-two patients were safely discharged
from hospital and scheduled for an elective repair during the first month. Thirty-four
patients were operated emergently. Five patients had successful taxis but with a reduction
of posttaxis VAS score less than 50% (a mean reduction from 86 to 62 mm), while taxis
failed in twenty-nine patients. Patients with emergency surgery had longer time until
reduction and longer stay of hospitalization. In this group, two patients required
admission to the intensive care unit while one patient died.
Conclusion In this protocolized approach, taxis is a safe and feasible option for most patients
with incarcerated hernias. It should be kept in our armament, especially in times
when emergency surgery capabilities are under strain like the ongoing COVID-19 pandemic.
Keywords
hernia - visual analog pain score - coronavirus - manual reduction - taxis
