Prospective evaluation of the clinical presentation and outcomes of complicated groin hernias in an emergency surgical department at a resource-limited setting of North India

Groin hernias are highly common, with a lifetime inguinal hernia repair risk of 27% in men and 3% in women. A significant proportion of these hernias present as surgical emergencies due to incarceration or strangulation, with complication rates ranging from 10% to 37%. High-quality prospective data from northern India remain limited. Therefore, this study was undertaken to prospectively evaluate the clinical presentation, management and outcomes of complicated groin hernias. A prospective, single-centre observational study was conducted in patients who underwent emergency surgical repair for complicated groin hernias from January 2025 to June 2026. Demographic data, clinical features, white blood cell (WBC) counts, neutrophil-to-lymphocyte ratio (NLR), surgical techniques (including open mesh hernioplasty) and postoperative complications (graded via the Clavien-Dindo classification) were recorded and analysed using non-parametric statistics and logistic regression. Among 70 patients (median age 45 years; 85.7% male), 17.1% required bowel resection and anastomosis. The median duration of acute symptoms was 18.0 (IQR: 12.0–32.0) hours. Delayed presentation was significantly associated with surgical morbidity; patients needing bowel resection presented much later than those who did not (median 42.0 vs. 15.0 h, p = 0.0002). Every one-hour delay independently increased the odds of requiring bowel resection by 11.6% (OR = 1.116, p = 0.00017). Elevated WBC counts and NLR served as powerful independent predictors for ischaemia. At an optimal cut-off value of 3.45, NLR predicted the necessity of bowel resection with a sensitivity of 100% (95% CI: 73.5–100%) and a specificity of 79.3% (95% CI: 68.9–89.7%) (AUC = 0.91). The overall postoperative complication rate was 34.3% (95% CI: 23.2–45.4%), reflecting Grade I-inclusive morbidity. Non-mesh primary tissue repairs had higher complication rates compared to mesh repairs (52.9% [95% CI: 36.1–69.7%] vs. 16.7% [95% CI: 4.5–28.9%], p = 0.003), driven entirely by the severe contamination of the surgical field that precluded mesh use. Complicated groin hernias in northern India predominantly affect middle-aged males presenting late due to socioeconomic constraints. Open mesh hernioplasty is safe in the absence of gross contamination. Elevated NLR combined with emergency ultrasonography serves as a reliable, low-cost adjunct for predicting bowel necrosis when CT imaging is unavailable. Early diagnosis and timely referral remain the key factors in improving outcomes and reducing hospital stays.