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 from 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 and manual reduction. 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 24 h 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 should undergo a short period of observation. Urgent surgery can be undertaken during the same admission or up to several weeks later. CONCLUSIONS: Taxis is a benign/non-invasive method for patients with an acute, non-strangulated 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.

2nd Faculty of Medicine Charles University Prague Czech Republic

3rd Department of Surgery at 1st Faculty of Medicine at Charles University Motol University Hospital Prague Czech Republic

Comprehensive Hernia Centre North Devon District Hospital Raleigh Heights Barnstaple EX31 4JB UK

Royal Infirmary of Edinburgh Edinburgh UK

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O’Toole MT. Mosby’s medical dictionary. 9. Elsevier; 2013.

Garg G, Jenaw R, Chaudhary S, Garg KM. How safe is taxis in hernia? Reduction of gangrenous omentum-an uncommon occurrence. IOSR J Dent Med Sci. 2014;13:52–53. doi: 10.1007/s10029-008-0467-9. DOI

Primatesta P, Goldacre MJ. Inguinal hernia repair: incidence of elective and emergency surgery, readmission and mortality. Int J Epidemiol. 1996;25:835–839. doi: 10.1093/ije/25.4.835. PubMed DOI

Harissis HV, Douitsis E, Fatouros M. Incarcerated hernia: to reduce or not to reduce? Hernia. 2009;13:263–266. doi: 10.1007/s10029-008-0467-9. PubMed DOI

Stabilini C, East B, Fortelny R, et al. European Hernia Society (EHS) guidance for the management of adult patients with a hernia during the COVID-19 pandemic general concepts. Hernia. 2020;1:3. doi: 10.1007/s10029-020-02212-8. PubMed DOI PMC

Nilsson E, Kald A, Anderberg B, et al. Hernia surgery in a defined population: a prospective three year audit. Eur J Surg. 1997;163:823–829. PubMed

Cheek CM, Primatesta P, Goldacre N. Inguinal hernia repair: incidence of elective and emergency surgery, readmission and mortality. Int J Epidemiol. 1997;26:459–461. doi: 10.1093/ije/26.2.459. PubMed DOI

Montgomery J, Dimick JB, Telem DA. Management of groin hernias in adults—2018. JAMA. 2018;320:1029. doi: 10.1001/jama.2018.10680. PubMed DOI

Hernández-Irizarry R, Zendejas B, Ramirez T, et al. Trends in emergent inguinal hernia surgery in Olmsted County, MN: a population-based study. Hernia. 2012;16:397–403. doi: 10.1007/s10029-012-0926-1. PubMed DOI PMC

Simons MP, Smietanski M, Bonjer HJ, et al. International guidelines for groin hernia management. Hernia. 2018;22:1–165. doi: 10.1007/s10029-017-1668-x. PubMed DOI PMC

Birindelli A, Sartelli M, Di Saverio S, et al. 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias. World J Emerg Surg. 2017;12:37. doi: 10.1186/s13017-017-0149-y. PubMed DOI PMC

Kluger Y, Ben-Ishay O, Sartelli M, et al. World society of emergency surgery study group initiative on timing of acute care surgery classification (TACS) World J Emerg Surg. 2013;8:1–6. doi: 10.1186/1749-7922-8-17. PubMed DOI PMC

BNF: British National Formulary—NICE. https://bnf.nice.org.uk/drug/. Accessed 25 Dec 2019

Academy of Medical Royal Colleges (2013) Safe Sedation Practice for Healthcare Procedures: Standards and Guidance | The Royal College of Anaesthetists. https://www.aomrc.org.uk/wp-content/uploads/2016/05/Safe_Sedation_Practice_1213.pdf

Koizumi M, Sata N, Kaneda Y, et al. Optimal timeline for emergency surgery in patients with strangulated groin hernias. Hernia. 2014;18:845–848. doi: 10.1007/s10029-014-1219-7. PubMed DOI

Chen S-C, Lee C-C, Liu Y-P, et al. Ultrasound may decrease the emergency surgery rate of incarcerated inguinal hernia. Scand J Gastroenterol. 2005;40:721–724. doi: 10.1080/00365520510015485. PubMed DOI

LeBlanc KA, Kingsnorth A, Sanders DL. Management of abdominal hernias. Springer International Publishing; 2018.

Icoz G, Makay O, Sozbilen M, et al. Is D-dimer a predictor of strangulated intestinal hernia? World J Surg. 2006;30:2165–2169. doi: 10.1007/s00268-006-0138-x. PubMed DOI

Wu SC, Wang CC, Sheen-Chen SM. Intestinal obstruction caused by intraoperative mass reduction of an incarcerated inguinal hernia-report of a case. Int J Surg. 2008;6:e103–e105. doi: 10.1016/j.ijsu.2007.04.017. PubMed DOI

Arima T, Muroya K, Kawamoto K, et al. Laparoscopic relief of reduction en masse followed by elective preperitoneal inguinal hernia repair with modified KugelTM patch. Int J Surg Case Rep. 2018;50:97–99. doi: 10.1016/j.ijscr.2018.07.026. PubMed DOI PMC

Wright SW, Chudnofsky CR, Dronen SC, et al. Comparison of midazolam and diazepam for conscious sedation in the emergency department. Ann Emerg Med. 1993;22:201–205. doi: 10.1016/S0196-0644(05)80203-3. PubMed DOI

Section and Board of Anaesthesiology EU of MS Guidelines for sedation and/or analgesia by non-anaesthesiology doctors. Eur J Anaesthesiol. 2007;24:646–647. doi: 10.1017/S0265021507000452. PubMed DOI

Benger J, Gray A, Lloyd G, Norris A, Strachan R, Telford LGR. Safe sedation of adults in the emergency department. Royal College of Anaesthetists; 2012.

Aubrun F, Mazoit J-X, Riou B. Postoperative intravenous morphine titration. Br J Anaesth. 2012 doi: 10.1093/bja/aer458. PubMed DOI

Malamed SF. Sedation: a guide to patient management. Anesth Prog. 2005;52:43–44. doi: 10.2344/0003-3006(2005)52[43:SAGTPM]2.0.CO;2. DOI

Brunicardi F, et al. Schwartz’s principles of surgery. 10. McGraw Hill Education; 1980.

Henry K. Hernia: anatomy, etiology, symptoms, diagnosis, differential diagnosis, prognosis, and the operative and injection treatment. By Leigh F. Watson, M.D., Member of Attending Staff of California Lutheran Hospital and Methodist Hospital of Southern California. Br J Surg. 1938;26:452–452. doi: 10.1002/bjs.18002610234. DOI

Pérez JAÁ, Baldonedo RF, Bear IG, et al. Emergency hernia repairs in elderly patients. Int Surg. 2003;88:231–237. PubMed

Yang XF, Liu JL. Acute incarcerated external abdominal hernia. Ann Transl Med. 2014;2:1–9. doi: 10.3978/j.issn.2305-5839.2014.11.05. PubMed DOI PMC

Koivusalo A, Pakarinen MP, Rintala RJ. Laparoscopic herniorrhaphy after manual reduction of incarcerated inguinal hernia. Surg Endosc. 2007;21:2147–2149. doi: 10.1007/s00464-007-9318-5. PubMed DOI

Sgourakis G, Radtke A, Sotiropoulos GC, et al. Assessment of strangulated content of the spontaneously reduced inguinal hernia via hernia sac laparoscopy: preliminary results of a prospective randomized study. Surg Laparosc Endosc Percutan Tech. 2009;19:133–137. doi: 10.1097/SLE.0b013e31819d8b8b. PubMed DOI

Sawayama H, Kanemitsu K, Okuma T, et al. Safety of polypropylene mesh for incarcerated groin and obturator hernias: a retrospective study of 110 patients. Hernia. 2014;18:399–406. doi: 10.1007/s10029-013-1058-y. PubMed DOI

Tebala GD, Kola-Adejumo A, Yee J. Hernioscopy: a reliable method to explore the abdominal cavity in incarcerated or strangulated inguinal hernias spontaneously reduced after general anaesthesia. Hernia. 2019;23:403–406. doi: 10.1007/s10029-019-01901-3. PubMed DOI

Update of the international HerniaSurge guidelines for groin hernia management