key: cord-0917958-pgiy1efo
authors: Lima, D. L.; Pereira, X.; dos Santos, D. C.; Camacho, D.; Malcher, F.
title: Where are the hernias? A paradoxical decrease in emergency hernia surgery during COVID-19 pandemic
date: 2020-06-16
journal: Hernia
DOI: 10.1007/s10029-020-02250-2
sha: 949c40ad905de3c559d0e14accc4164da894487a
doc_id: 917958
cord_uid: pgiy1efo

nan

hernia with bowel resection and one incisional hernia). During the same period in 2019, we had 18 emergency hernia cases; 7 inguinal and 11 ventral repairs, 2 of which incisional hernias. At our hospital, we have a dedicated abdominal wall program that performs roughly 1500 hernia repairs annually. Thus, when elective procedures were cancelled, we expected an increased number of hernia-related surgical emergencies. Yet, we experienced the opposite. The proportion of emergency to elective hernia surgeries in 2020 was significantly lower when compared to the same period of 2019 (1.9% vs 4.9%, p = 0.03). Following a similar trend, consultations for hernia-related pathologies decreased by 66% during the pandemic.

In recent years, multiple authors have proposed early repair of inguinal hernia to prevent complications such as strangulation and obstruction, which they collective name hernia accidents [3] . A recent meta-analysis showed that an elective repair has a 0.2% mortality rate, while a hernia accident has a mortality of 4% [3] . However, randomized controlled trials have showed that a watchful waiting approach (WWA) for high-risk patients is safe with a low incidence of complications [3] . Gong and Li compared the results of eight trials with a WWA and concluded it is safe in the shortterm for asymptomatic or minimally symptomatic inguinal hernias [4] . For ventral hernias, symptoms of pain and risk of strangulation or incarceration are the classic indications for a repair [5] . Only recently have studies started to consider a WWA for specific high-risk patients [5] . Nonetheless, the factors leading to failure of WWA are not clearly defined for either type of hernia (Table 1) .

Overall, our institution experienced a drastic reduction of hernia-related emergency cases and number of consultations for hernia-related pathologies during the COVID-19 pandemic. Although the decrease in volume is multifactorial, it does highlight a few important considerations of particular interest to hernia specialists. Chiefly, what is the true incidence of hernia-related emergencies requiring prompt surgical attention? It is likely that many patients have unknowingly self-selected a WWA given the constraints of the COVID-19 pandemic, revealing a much lower incidence of hernia-related emergencies. If this is the case, are we overusing emergency hernia surgery, which we know comes with inferior results and higher complications rates?

These questions remain difficult to answer, especially with a limited observation over 2 months during a worldwide pandemic, but they bring us back to our initial consideration; where did the hernia-related emergencies go during the COVID-19 pandemic?

Funding There was no funding for this research.

Ethical approval IRB for the approved study (IRB number 2020-11160).

The authors declare that the procedures followed were in accordance with the ethical standards of the institutional committee (IRB number 2020-11160) responsible for human experimentations.

Informed consent Informed consent was not applicable.

Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 

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Watchful waiting as a treatment strategy for patients with a ventral hernia appears to be safe