Comments on “Hematologic and Biochemical Markers in Predicting Bowel Resection for Incarcerated Hernias”

We read the recently published article titled “Hematologic and Biochemical Markers in Predicting Bowel Resection for Incarcerated Hernias” by Yılmaz et al. with great interest [1]. In this study, the authors emphasized the importance of laboratory values in predicting the necessity of bowel resection in incarcerated hernias [1]. Laboratory values are important diagnostic tools in the evaluation and management of the patient's clinical status. They are among the first tests sought, particularly in determining the state of inflammation and the severity of the disease. Access to advanced imaging methods such as ultrasonography (USG) and computed tomography (CT) may not always be easy. Physicians, especially in rural areas, may experience difficulties in accessing imaging methods. The diagnostic sensitivity of USG decreases in cases of ileus where intestinal obstruction develops. On the other hand, kidney functions are adversely affected due to the disruption of fluid and electrolyte balance in hernias with intestinal obstruction. This situation creates a handicap for contrast-enhanced CT scans performed for diagnostic purposes. However, routine blood values are easily accessible, inexpensive, and harmless to the patient. In an inflammatory event such as an incarcerated hernia, laboratory values are critically important for evaluating the disease. Studies to be conducted on this subject are valuable, and it is necessary to keep this topic on the agenda and discuss it. For all these reasons, the authors' current study is very important. The large number of patients in the study also strengthens the study. However, some points in this article need to be revisited and discussed. We have some comments to criticize or support the authors' study. Firstly, the authors paid attention to patient selection because laboratory parameters are affected by various diseases. However, patients with comorbid diseases were included in the study. Although no significant difference was detected in terms of comorbidities, they were more frequently observed in the resection group. Even if a single comorbidity does not significantly affect blood values, the presence of more than one comorbidity in the same patient will significantly affect laboratory values, and these patients should be excluded from the study. Secondly, the use of a control group in studies is valuable. Patients whose incarcerated hernia was reduced into the abdomen and not operated on (n = 21 patients) could have formed a group. Thus, in addition to the necessity of bowel resection, the need for surgery could also be determined. Forming three groups could make the study stronger. Thirdly, information regarding mesh usage was given in the study and appears to have been discussed in the discussion section. This section is not aligned with the aim of the study and could have been removed from the study. Finally, similar blood values showed diagnostic efficacy in our study, parallel to the authors' study. In our study, the diagnostic efficacy of bilirubin levels in determining the necessity of bowel resection was found to be higher than other parameters (AUC: 0.809, sensitivity: 70%, specificity: 83%, LR+: 4.11) [2]. Bilirubin levels increase in many inflammatory diseases. In intestinal ischemia secondary to strangulated hernia, bacteria such as E. coli cause hemolysis and endotoxemia. In the presence of endotoxemia, the liver's uptake of bilirubin decreases, which also increases the excretion of bilirubin into the canaliculi, consequently raising blood bilirubin levels [3, 4]. Thus, using the bilirubin value in your current study or in future studies may yield better results. Furthermore, lipase, indirect bilirubin, phosphorus, total bilirubin, and creatinine are important parameters that can be used as diagnostic tools in intestinal ischemia. We congratulate the authors once again for their successful study, and we eagerly await their response to our comments and criticisms. All authors have contributed to our article and agree to submit it to the “ANZ journal of Surgery” for publication. The authors declare no conflicts of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request.