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Abdominal wall hernias may result in pain, discomfort and aesthetic dissatisfaction and remain an important surgical challenge . Moreover, hernias may be associated with significant morbidity and in rare cases mortality due to incarceration of bowel or abdominal contents such as fat or omentum [2–4]. Incarceration of the bowel is an absolute indication for emergency surgery. Previous research has shown prevalence rates of 4–15% of abdominal wall hernias resulting in emergency surgery. Emergency surgery is associated with severely compromised outcomes and increased mortality as compared to elective hernia repair [2, 3, 5, 6].
Risk of incarceration may be increased due to factors increasing intra-abdominal pressure. Obesity, ascites, chronic cough, and constipation are factors that all have been reported to increase intra-abdominal pressure [4, 7–9]. Hernia characteristics such as defect location and defect size may be associated with incarceration as well. Smaller defects are often thought to be at increased risk for incarceration; however, the evidence supporting this theory is limited. In fact, a previous study found no evidence for an increased incarceration risk in defects below 2 cm and another recent study found no association at all between defect size and hernia incarceration [4, 6].
The primary objective of this prospective study was to evaluate the relation of defect size and location with incarceration in primary and incisional hernias. Secondary objectives comprised identification of additional patient factors associated with an incarcerated hernia.