American journal of surgery
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Elective repair of simple (uncomplicated) inguinal and femoral hernias avoids incarceration and bowel obstruction (complicated presentations). To identify factors that perturb this strategy, we analyzed the records of 1,859 consecutive nonpediatric patients with groin hernias. Incarceration or bowel obstruction prompted operation in 22 of 77 (29%) women and in 15 of 34 (44%) patients with femoral hernia. ⋯ Complicated presentations of groin hernias are associated with a higher proportion of women and patients with femoral hernias. Gangrenous bowel was encountered only in those patients with groin hernia and bowel obstruction. Early diagnosis and elective repair of uncomplicated hernias should remain our strategy in patients of all ages.
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In a 12-year period, 188 patients with penetrating wounds to the anterior neck were managed selectively. The 69 symptomatic patients were explored promptly. The remaining 119 patients (63%) were observed in the hospital using ancillary diagnostic tests based on injury location and trajectory. ⋯ In the observed group, one patient (0.8%) required delayed exploration for an occult injury. Average hospital stay for patients after neck exploration was 8.4 days, for patients after negative exploration 4.2 days, and for patients after observation 1.7 days. This ongoing experience confirms the efficacy and safety of selective neck exploration in a Level I Trauma Center.