Outcomes of Minimally Invasive versus Open Surgery for Incarcerated or Strangulated Abdominal Wall Hernia Repair

Emergency repair of acutely incarcerated or strangulated abdominal wall hernias requires prompt reduction, assessment of bowel viability and definitive repair, with the operative approach influenced by the patient's physiological condition, the degree of contamination and the need for bowel resection. This narrative review examines outcomes of minimally invasive surgery (MIS) compared with open repair, focusing on feasibility, postoperative outcomes, patient selection, mesh use and surgical expertise. The available literature suggests that laparoscopic repair, particularly transabdominal pre-peritoneal (TAPP) repair for groin hernias, is feasible in selected patients and may be associated with shorter hospital stays and fewer wound complications. MIS can also permit direct assessment of bowel viability and, in appropriately equipped and experienced centres, bowel resection when required. However, suspected ischaemia or the need for resection demands careful assessment, and perforation, generalised peritonitis, extensive contamination, haemodynamic instability or inadequate laparoscopic access may favour open surgery or prompt conversion. Mesh may reduce recurrence in selected emergency repairs, although infection risk becomes more relevant with bowel resection and contamination. Interpretation of comparative outcomes is limited by predominantly retrospective evidence, selection bias, variation in hernia types and operative techniques, and inconsistent long-term follow-up. Current evidence therefore supports MIS as a selective option rather than a universally superior approach. Prospective multicentre studies with standardised definitions and long-term assessment of recurrence, reoperation, chronic pain and functional recovery are needed.