763 Emergency Ventral Hernias Management at a Large Tertiary Hospital Against World Society of Emergency Surgery (WSES) Recommendations: 7 Years' Experience

Aim Ventral hernia (VH) is a common condition in general surgery. Management is conservative or surgical (either electively or emergently). Approximately 10% require emergency surgery, which is associated with higher rates of post-operative complications and mortality. This retrospective audit aims to compare performances of emergency VH management at a tertiary hospital in London over the last 7 years against the 2017 WSES. The study focuses on timing of surgery after emergency admissions, co-morbidities, size of the hernia defect, and post-operative complications. Method 268 patients (excluding those aged <16) with non-elective VH were identified from patient coding, radiology reports, and patient notes between 2016 and 2023. Cases were analysed in detail with single/multiple attendances, from admission in ED to definitive treatment, focusing on the most relevant co-morbidities in patients with VH, and correlated post-operative complications (inpatient/at 30 days/6 month/1 year). Results Many patients with a non-contaminated surgical field could have benefited from mesh implant. No evidence on the notes of discussions on single non-elective VH, such as MDT meetings, before operating or opting for conservative management. Patients with multiple admissions, especially those with co-morbidities, had higher rates of post-operative complications. Conclusions A great proportion of patients with a non-contaminated surgical field could have benefited from mesh implant. A longer observational period may be warranted for patients who have had abdominal surgery and are co-morbid for early detection of incisional hernias. Implementation of laparoscopic surgery has the potential to decrease post-surgical complication rates. Consider earlier intervention in co-morbid patients to prevent emergency admission.