I remember in residency calling general surgery for a hernia that could not be reduced. The surgeon was irritated and determined to prove it could be reduced. After about 30 minutes of sweat and tears the hernia was reduced and he instructed me to send the patient home. I later learned that his approach is generally frowned upon in the surgical literature, as forceful reduction can result in reduction en masse as well as perforation. In the days before emergency surgery was practiced, the technique of reduction was described as “taxis” which is a Greek word meaning “to draw up in rank and file.” One textbook disparages the notion, saying “vigorous taxis has no place in modern surgery, and it is only mentioned to be condemned.” That being said, There is an article challenging the notion that taxis was always wrong, and they found that it was safe and effective.(Harissis 2009)
The term “taxis” probably does not deserve its present obloquy. Reduction is safe if it is gentle and there is no bowel obstruction or strangulation. By using taxis (drawing the hernia up together, with slight traction and with lateral compression) the reduction is actually much more gentle.
First decompress the hernia. Grasp the hernia sac and gently squeeze. This evacuates some of the bowel contents, venous blood, and tissue fluid. The hernia shrinks and is more easily reduced. Less force is needed.
I have seen several umbilical hernias where other physicians struggled, and when I taught them this technique, the hernia was easily reduced.
Take home points:
Decompress hernias before reduction