Retrospective analysis of open preperitoneal hernioplasty in emergency settings: clinical outcomes and challenges.

PURPOSE: To evaluate the surgical and postoperative outcomes of open preperitoneal hernioplasty in emergency surgery for inguino-crural hernias, focusing on morbidity, complication rates, and the feasibility of the technique in elderly patients and surgeons not specialized in abdominal wall surgery. The aim is to provide evidence on the safety, efficacy, and applicability of this approach.

METHODS

Retrospective, observational, single-center study (2018–2023) including patients undergoing emergency open preperitoneal hernioplasty. Clinical, demographic, and surgical data were obtained from medical records and analyzed using descriptive and multivariate statistics with SPSS.

RESULTS

A total of 122 patients were analyzed (median age: 64 years; 53.3% over 80 years). Comorbidities were present in 86.9% of patients, most commonly cardiovascular. The most frequent hernia types were lateral (39.3%), followed by medial (36.1%) and femoral (24.6%). Intestinal obstruction was present in 37.7% at admission. Polypropylene mesh was used in all cases, primarily fixed with glue (86%). Only one conversion to laparotomy occurred. 73% of patients had no complications; 22.1% experienced minor complications (Clavien-Dindo I/II) and 4.9% major complications (III/IV). No significant differences were found between specialized and non-specialized surgeons. Recurrence rates were 0% at 6 months and 2.5% at 12 months, with follow-up losses of 22.1% and 35.2%, respectively.

CONCLUSION

Open preperitoneal hernioplasty is a safe, effective, and reproducible technique in emergency surgery. Its low complication profile, absence of conversion to midline laparotomy, and accessibility make it a viable option even for non-specialized surgeons. Its use should be encouraged and further compared with other surgical approaches.