Algorithm for the safe management of an incarcerated inguinal hernia in
the emergency setting including Taxis: the technique and its safety.
Background: An acute inguinal hernia remains a common emergency surgical
condition worldwide. While emergency surgery has a major role to play in
treatment of acute hernias, not all patients are fit for emergency
surgery, nor are facilities for such surgery always available. Taxis is
the manual reduction of incarcerated tissues from the hernia sack to its
natural compartment, and can help delay the need for surgery for days to
months. The aim of this study was to prepare a safe algorithm for
performing manual reduction of incarcerated inguinal hernias in adults.
Methods: Medline, Scopus, Ovid and Embase were searched for papers
related to emergency inguinal hernias. In addition, the British National
Formulary and Safe Sedation Practice for Healthcare Procedures:
Standards and Guidance were reviewed. Results: A safe technique of
manual reduction of an acute inguinal hernia, called GPS (Gentle,
Prepared and Safe) Taxis, is described. It should be performed within
24h from the onset of a painful irreducible lump in groin, and when
concomitant symptoms and signs of bowel strangulation are absent.
Conscious sedation guidelines should be followed. The most popular drug
combination is of intravenous morphine and short acting benzodiazepine,
both titrated carefully for optimal and safe effect. The dose of drugs
must be individualised, and the smallest effective dosage should be used
to avoid oversedation. Following successful taxis, the patient can be
safely discharged after a short period of observation to return form
more planned urgent surgery. Conclusions: Taxis is a feasible and safe
method for patients with an incarcerated inguinal hernias. It likely
reduces the risk and complications of anaesthesia and surgery in the
emergency settings. GPS Taxis should be considered as first line
treatment in the majority of patients presenting with an acute inguinal
hernia when existing bowel infarction is unlikely.