Retrospective analysis of 1,211 operated patients due to groin hernia with open surgical approach – single center experience

Miroslav Marković; Mihailo Bezmarevic; Milan Ilić; Marina Dragičević; Aleksandar Andrić

doi:10.2298/VSP151125319M

Miroslav Marković Military Medical Academy, Clinic for General Surgery, Belgrade
Mihailo Bezmarevic Military Medical Academy, Clinic for General Surgery, Belgrade
Milan Ilić Primary Helth Center, Novi Sad
Marina Dragičević Clinical Center of Vojvodina, Clinic for Hemathology, Novi Sad
Aleksandar Andrić Military Center, Department of Surgery, Novi Sad

DOI: https://doi.org/10.2298/VSP151125319M

Keywords: hernia, inguinal;, hernia, femoral;, men;, women;, age of onset;, incidence;, surgical procedures, operative;, postoperative complications

Abstract

Bacground/Aim. Groin hernias are common pathology among men population. Only curative treatment is surgical reparation with various surgical procedures for groin hernia solving. The aim of this study was to evaluate the most prevalent surgical procedures and early postoperative complications after groin hernia reparation in large series of operated patients, and to assess the morphologic characteristics of groin hernias. Methods. The retrospective study included all patients with groin hernia who underwent surgical reparation from 2009 to 2012. In all patients a demographic characteristics, including gender and age, clinical characteristics and hernia type were analyzed. The surgical procedure for hernia solving and early postoperative complications were assessed. Results. The study included 1,211 patients. The male/female ratio was 1,127/84 (p < 0.001). Inguinal hernia was found in 1,195 patients (94.5% males). Femoral hernia was found in 16 patients (25% males and 75% females). Significant difference in distribution of inguinal and femoral hernia between genders was found (p < 0.001). In males right sided inguinal hernia was present in 57.6%. In females right sided inguinal hernia was present in 7 and left sided in 5 patients. Sixsten patients had bilateral inguinal hernia, all in males. There was no significant difference in side of inguinal hernia occurrence and gender. Right sided and left sided femoral hernias were present in the same percent in males. In females a higher occurrence in femoral hernia was found on the right side then on the left one (7:5) without significant difference. There were 71.1% of patients in the age group of 51–80 and 27.2% of patients in the age group of 61–70. Surgical procedures included: Lichtenstein in 51.2% of patients, nylon-darn in 29.6% of patients, Bassini in 16.2% of patients, Lothaissen in 1.7% of patients, and Halsted in 1.4% of patients. Overall, postoperative complications were present in 78 (6.4%) of patients. Wound infection was the most common complication, occurred in 2.4% of patients. Conclusion. Prevalence of inguinal hernias is higher in men population, while femoral hernias are more common in females. The most affected population is at the age between 61 and 80 years. The most commonly used open surgical procedures for groin hernia reparation are Lichtenstein and nylon-darn. Both methods have low and similar incidence rates of postoperative complications.

References

Malangoni MA, Rosen MJ. Hernias. In: Townsend CM Jr, Beau-champ RD, Evers BM, Mattox KL, editors. Sabiston Textbook of Surgery. Philadelphia, PA: Elsevier; 2012. Chap 46.

Kingsnorth A, LeBlanc K. Hernias: inguinal and incisional. Lancet 2003; 362(9395): 1561−71.

Pans A, Pierard GE, Albert A, Desaive C. Adult groin hernias: New insight into their biomechanical characteristics. Eur J Clin Invest 1997; 27(10): 863−8.

Jorgensen LN, Kallehave F, Christensen E, Siana JE, Gottrup F. Less collagen production in smokers. Surgery 1998; 123(4): 450−5.

Skandalakis JE, Colborn GL, Skandalakis LJ. The embryology of the inguinofemoral area: An overview. Hernia 1997; 1(1): 45−54.

Javid PJ, Brooks DC. Hernias. In: Zinner MJ, Ashley SW, editors. Maingots Abdominal Operations. 11th ed. New York: McGraw-Hill; 2007. p. 103−39.

Miserez M, Alexandre JH, Campanelli G, Corcione F, Cuccurullo D, Pascual MH, et al. The European hernia society groin hernia classification: Simple and easy to remember. Hernia 2007; 11(2): 113−6.

Schumpelick V, Treutner KH, Arlt G. Classification of inguinal hernias. Chirurg 1994; 65(10): 877−9.

Fitzgibbons RJ, Filipi CJ, Quinn TH. Inguinal Hernias. In: Bruni-cardi FC, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Pollock RE, editors. Schwartz's Principles of Surgery. 8th ed. New York: McGraw Hill; 2005. p. 1354.

Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 2009; 13(4): 343−403.

Pešić I, Karanikolić A, Đorđević N, Stojanović M, Stanojević G, Ra-dojković M, et al. Incarcerated inguinal hernias surgical treatment specifics in elderly patients. Vojnosanit Pregl 2012; 69(9): 778−82.

Burcharth J, Pedersen M, Bisgaard T, Pedersen C, Rosenberg J. Nationwide prevalence of groin hernia repair. PLoS ONE 2013; 8(1): e54367.

Langeveld-Benders HR. Inguinal Hernia Surgery: a patient cen-tered approach. Erasmus University Rotterdam. [retrieved from 2014 December 10]. Available from: http://hdl.handle.net/1765/77245

Resanović A. Analysis of the postoperatiove complications after tension and nontension techniques of groin hernia repair. Bel-grade, Serbia; School of Medicine: 2008.

Phillips W, Goldman M. Groin Hernia. In: Stevens A, Raftery J, Mant J, Simpson S , editors. Health Care Needs Assessment. Birmingham: University of Birmingham; 2004. p. 671−721.

Williams NS, Bulstrode CJ, O'Connell PR. Bailey and Love's Short Practice of Surgery. 25th ed. London: Hodder Arnold; 2008.

Russell RC, Williams NS, Bulstrode CJ. Bailey and Love's Short Practice of Surgery, 23rd ed. London: Hodder Arnold; 2000.

Millikan KW, Deziel DJ. The management of hernia. Considerations in cost effectiveness. Surg Clin North Am 1996; 76(1): 105−16.

Bisgaard T, Bay-Nielsen M, Christensen IJ, Kehlet H. Risk of recurrence 5 years or more after primary Lichtenstein mesh and sutured inguinal hernia repair. Br J Surg 2007; 94(8): 1038−40.

Žuvela M. Modifikovana Rivesova tehnika u lečenju preponskih kila. (rad iz uže specijalizacije). Belgrade: Faculty of Medicine, University of Belgrade; 2005. (Serbian)

Lichtenstein IL, Shulman AG, Amid PK, Montllor MM. The ten-sion-free hernioplasty. Am J Surg 1989; 157(2): 188−93.

Amid PK. Lichtenstein tension-free hernioplasty: its inception, evolution, and principles. Hernia 2004; 8(1): 1−7.

Droeser RA, Dell-Kuster S, Kurmann A, Rosenthal R, Zuber M, Metzger J, et al. Long-term follow-up of a randomized con-trolled trial of Lichtenstein's operation versus mesh plug repair for inguinal hernia. Ann Surg 2014; 259(5): 966−72.

Parlak O. Comparisson of Lichtenstein and Darn Repair Techniques in Terms of Recurrence. Med J Islamic World Acad Sci 2015; 23(3): 81−3.

Maloney GE. Gill WG, Barclay RC. Operations for hernia; technique of nylon darn. Lancet 1948; 2(6515): 45−8.

Michael J, Zinner MD. Maingot's abdominal operations. 12. th. ed. New York: McGraw-Hill Medical; 2012.

El-Bakry AA. Plication darn for the repair of inguinal hernia. A university hospital experience. Saudi Med J 2002; 23(11): 1347−9.

Chakraborty S, Mukherjee A, Bhattacharya M. Tension-free in-guinal hernia repair comparing ‘darn' with ‘mesh': A prospec-tive randomized controlled clinical trial. Indian J Surg 2007; 69: 52−6.

Brygel M, Bonato LJ, Farah SS. Chronic Pain Review Following Lichtenstein Hernia Repair: A Personal Series. Surg Sci 2012; 3: 430−5.