Factors Associated With Manual Reduction of Incarcerated Inguinal Hernia in Children

Background: In patients with incarcerated inguinal hernia, initial manual reduction, which is not always feasible, rather than immediate surgery, is associated with fewer complications. The aim of the study was to evaluate factors associated with successful manual reduction of incarcerated inguinal hernia in children.
Methods: A prospective cohort study between January 2010 and December 2014 of children admitted with incarcerated inguinal hernia to a single surgical unit.
Results: A total of 34 patients with a median age of 4.2 months (range: 2 weeks to 14 years) were recruited. Manual reduction was attempted in 23 (67.6%) patients and successful in 13 (56.5%). A total of 9 (26.5%) patients had bowel strangulation. Shorter incarceration (median of 18.2 vs. 48.4 hours, p = 0.004) and longer duration of previous swelling (median of 20 vs. 3.5 weeks, p = 0.029) were associated with successful manual reduction. Bowel strangulation rate was higher amongst patients excluded from manual reduction, using the set criteria, compared to those who had failed reduction (77.8% vs. 22.2%, p = 0.044).
Conclusions: Manual reduction is more likely to be successful in patients who present early after incarceration as well as those with wider internal rings.

Keywords
children, incarceration, inguinal hernia, manual reduction, strangulation