Clinical predictors of bowel resection in incarcerated femoral hernias: A single-center cohort study.

PURPOSE: Incarcerated femoral hernias carry a notoriously high risk of bowel strangulation due to the rigid anatomy of the femoral ring. This study aimed to determine the clinical, demographic, and baseline laboratory predictors of irreversible bowel ischemia requiring resection in a strictly homogeneous cohort of patients undergoing emergency surgery for incarcerated femoral hernias.

METHODS

A retrospective cohort study was conducted on 100 consecutive patients who underwent emergency surgical repair for incarcerated femoral hernias between January 2019 and December 2023 at a single tertiary referral center. Patients were stratified into two cohorts based on the intraoperative requirement for bowel resection: the Resection Group (n = 23) and the Non-Resection Group (n = 77). Preoperative clinical data, demographic features, body mass index (BMI), symptom duration, and admission white blood cell (WBC) counts were analyzed using univariate analysis and multivariate binary logistic regression to isolate independent risk factors.

RESULTS

Intestinal resection was required in 23% of cases. In the multivariable logistic regression model, an elevated admission white blood cell (WBC) count (OR = 1.24, 95% CI: 1.09-1.41, p < 0.001) and prolonged symptom duration (OR = 1.72, 95% CI: 1.05-2.82, p = 0.031) were identified as independent predictors of bowel resection. ROC analysis identified a WBC cut-off of 12.3 × 103/µL (AUC: 0.784) and a symptom duration threshold of 1.5 days (AUC: 0.675). In a post-hoc subgroup analysis, patients presenting with both a WBC count and symptom duration above these thresholds had a bowel resection rate of 81.8% (9/11); however, this descriptive finding should be interpreted with caution because of the small subgroup size.

CONCLUSION

Admission leukocytosis and prolonged symptom duration were identified as independent predictors of bowel resection in patients with incarcerated femoral hernias. These readily available clinical parameters may assist in preoperative risk stratification; however, the post-hoc subgroup findings should be interpreted with caution and require prospective multicenter validation.