Manual Closed Reduction of Incarcerated Hernia: Is It Safe in the Emergency Department?

Background: Emergency surgical repair is the standard approach to the management of an incarcerated abdominal watt hernia (IAWH). In cases of very high-risk patients, manual closed reduction (MCR) of IAWH may prevent the need for emergency surgery. Objectives: To evaluate the safety, success rate, and complications of MCR in the management of IAWH conducted in an emergency department. Methods: The data of all patients who underwent MCR between 2012 and 2018 were retrospectively collected. Patient demographics, presenting symptoms, clinical parameters, and management during the hospitalization were retrieved from the medical charts. Results: Overall, 548 patients underwent MCR during the study period. The success rate was 25.4% (139 patients). One patient had a complication that required a laparotomy 2 days after his discharge. A recurrent incarceration occurred in 23%, 60% of them underwent successful repeated MCR and the others underwent emergency surgery. Six patients (1.4%) had a bowel perforation after a failed MCR. Conclusions: MCR can be performed safely in the emergency department and should be consider as an option to treat IAWH, especially in high operative risk patients.