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Safety of Elective Inguinal Hernia Repair in the Geriatric Population: A Retrospective Analysis

Year 2025, Volume: 22 Issue: 2, 313 - 316, 27.06.2025
https://doi.org/10.35440/hutfd.1583428

Abstract

Background: Inguinal hernia (IH) repair is generally considered safe with low morbidity and mortali-ty; however, the risk increases in geriatric patients due to the prevalence of comorbid conditions. This study aims to compare the outcomes of elective versus emergency IH repair in elderly pa-tients.
Materials and Methods: Patients aged 65 years and older who underwent surgery for IH at Balıklıgöl State Hospital and Akçakale State Hospital between 01.12.2022 and 01.02.2024 were retrospec-tively reviewed. The patients were divided into two groups as emergency (G-EM) and elective (G-EL) surgery. Age, gender, comorbidities, type of operation, length of hospitalization and postoperative complications were recorded. Postoperative complications were recorded as wound infection, seroma and ileus.
Results: The study included 72 patients. Sixty-one (84.7%) patients were in the G-EL group and 11 (15.3%) were in the G-EM group. The G-EL group was composed entirely of males, with a mean age of 70.9 years (range: 65-86), while the G-EM group included 6 males (54.5%) and 5 females (45.5%), with a mean age of 71.2 years (range: 65-89). The length of hospitalization was significantly shorter in the G-EL group (1.39 ± 0.62 days) compared to the G-EM group (4.50 ± 2.51 days, p < 0.001). Postoperative complications were occurred in 5 (45.6%) patients in the G-EM group and in 7 (11.5%) patients in the G-EL group, a significant difference was found (p=0.015). No mortality was observed in both groups.
Conclusions: Although IH repair in the geriatric population is a concern due to comorbidities, we recommend elective mesh hernia repair for patients diagnosed with inguinal hernia to avoid the high complication rate after emergency repair as seen in our study and in the literature.

References

  • 1. Price R, Makasa E, Hollands M. World Health Assembly Reso-lution WHA68.15: "Strengthening Emergency and Essential Surgical Care and Anesthesia as a Component of Universal Health Coverage"—Addressing the Public Health Gaps Arising from Lack of Safe, Affordable and Accessible Surgical and Anesthetic Services. World J Surg. 2015; 39(9):2115-25.
  • 2. Itani KMF, Fitzgibbons R. Approach to Groin Hernias. JAMA Surg. 2019; 154(6):551-552.
  • 3. Nano M. Technique for inguinal hernia repair in the elderly patient. Am J Surg. 1983; 146(3):373-5.
  • 4. Tonelli, C., Ringhouse, B., Bunn, C. et al. The Impact of the Aging Population on Surgical Diseases. Curr Geri Rep ,2021; 10:21–31.
  • 5. Kraft BM, Kolb H, Kuckuk B, Haaga S, Leibl BJ, Kraft K, Bittner R. Diagnosis and classification of inguinal hernias. Surg En-dosc. 2003; 17(12):2021-4.
  • 6. van Veenendaal N, Simons M, Hope W, Tumtavitikul S, Bon-jer J; HerniaSurge Group. Consensus on international guide-lines for management of groin hernias. Surg Endosc. 2020; 34(6):2359-2377.
  • 7. Miserez M, Peeters E, Aufenacker T, Bouillot JL, Campanelli G, Conze J, et al Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal her-nia in adult patients. Hernia. 2014; 18(2):151-63.
  • 8. Yang W, Tao Z, Chen H, Li Q, Chu PG, Yen Y, et al. Amyand's hernia in elderly patients: diagnostic, anesthetic, and perio-perative considerations. J Invest Surg. 2009; 22(6):426-9.
  • 9. Kartal M. İleri Yaşlı Hastalarda (85 yaş ve üzeri) İnkarsere İnguinal Herni Cerrahisi Deneyimlerimiz. Osmangazi Tıp Der-gisi. 2021; 43(5):485-9.
  • 10. Abebe MS, Tareke AA, Alem A, Debebe W, Beyene A. Worldwide magnitude of inguinal hernia: Systematic review and meta-analysis of population-based studies. SAGE Open Med. 2022; 10:20503121221139150.
  • 11. Bal J, Ilonzo N, Spencer P, Hyakutake M, Leitman IM. Loss of independence after emergency inguinal hernia repair in el-derly patients: How aggressive should we be? Am J Surg. 2022; 223(2):370-374.
  • 12. Işıl RG, Yazıcı P, Demir U, Kaya C, Bostancı Ö, İdiz UO, et al. Approach to inguinal hernia in high-risk geriatric patients: Should it be elective or emergent? Ulus Travma Acil Cerrahi Dergisi. 2017; 23(2):122-127.
  • 13. Rørbaek-Madsen M. Herniorrhaphy in patients aged 80 years or more. A prospective analysis of morbidity and mortality. Eur J Surg. 1992; 158(11-12):591-4.
  • 14. Pokorny H, Klingler A, Schmid T, Fortelny R, Hollinsky C, Kawji R, et al. Recurrence and complications after laparos-copic versus open inguinal hernia repair: results of a pros-pective randomized multicenter trial. Hernia. 2008; 12(4):385-9.
  • 15. Ceresoli M, Carissimi F, Nigro A, Fransvea P, Lepre L, Braga M, et al List of Elderly Risk Assessment and Surgical Outcome (ERASO) Collaborative Study Group endorsed by SICUT, ACOI, SICG, SICE, and Italian Chapter of WSES. Emergency hernia repair in the elderly: multivariate analysis of morbidity and mortality from an Italian registry. Hernia. 2022; 26(1):165-175.
  • 16. Piltcher-da-Silva R, Sasaki VL, Bettini LFC, Soares PSM, Va-landro IG, Cavazzola LT. Outcomes of Emergency Groin Her-nia Repair in the Elderly: A Systematic Review. J Abdom Wall Surg. 2023; 2:11246.

Geriatrik Popülasyonda Elektif İnguinal Herni Onarımının Güvenliği: Retrospektif Analiz

Year 2025, Volume: 22 Issue: 2, 313 - 316, 27.06.2025
https://doi.org/10.35440/hutfd.1583428

Abstract

Amaç: Kasık fıtığı (İH) onarımı genellikle düşük morbidite ve mortalite ile güvenli kabul edilir; an-cak, komorbid durumların yaygınlığı nedeniyle geriatrik hastalarda risk artar. Bu çalışmanın amacı yaşlı hastalarda elektif ve acil İH onarımının sonuçlarını karşılaştırmaktır.
Materyal ve Metod: 01.12.2022 ile 01.02.2024 tarihleri arasında Balıklıgöl Devlet Hastanesi ve Akçakale Devlet Hastanesi'nde İH nedeniyle ameliyat edilen 65 yaş ve üzeri hastalar retrospektif olarak incelendi. Hastalar acil (G-EM) ve elektif (G-EL) cerrahi olmak üzere iki gruba ayrıldı. Yaş, cinsiyet, eşlik eden hastalıklar, ameliyat türü, hastanede yatış süresi ve ameliyat sonrası komplikasy-onlar kaydedildi. Ameliyat sonrası komplikasyonlar yara enfeksiyonu, seroma ve ileus olarak kaydedildi.
Bulgular: Çalışmaya 72 hasta dahil edilmiştir. Altmış bir (%84,7) hasta G-EL grubunda ve 11 (%15,3) hasta G-EM grubundaydı. G-EL grubu ortalama 70,9 yaş (dağılım: 65-86) ile tamamen erkeklerden oluşurken, G-EM grubu ortalama 71,2 yaş (dağılım: 65-89) ile 6 erkek (%54,5) ve 5 kadın (%45,5) içermekteydi. Hastanede yatış süresi G-EL grubunda (1.39 ± 0.62 gün) G-EM grubuna (4.50 ± 2.51 gün, p < 0.001) kıyasla anlamlı olarak daha kısaydı. Ameliyat sonrası komplikasyonlar G-EM grubunda 5 (%45,6) hastada görülürken, G-EL grubunda 7 (%11,5) hastada görülmüştür ve anlamlı bir fark bulunmuştur (p=0,015). Her iki grupta da mortalite gözlenmedi.
Sonuç: Geriatrik popülasyonda İH onarımı komorbiditeler nedeniyle endişe verici olsa da, çalışmamızda ve literatürde görüldüğü gibi acil onarım sonrası yüksek komplikasyon oranından kaçınmak için inguinal herni tanısı alan hastalara elektif mesh herni onarımını öneriyoruz.

References

  • 1. Price R, Makasa E, Hollands M. World Health Assembly Reso-lution WHA68.15: "Strengthening Emergency and Essential Surgical Care and Anesthesia as a Component of Universal Health Coverage"—Addressing the Public Health Gaps Arising from Lack of Safe, Affordable and Accessible Surgical and Anesthetic Services. World J Surg. 2015; 39(9):2115-25.
  • 2. Itani KMF, Fitzgibbons R. Approach to Groin Hernias. JAMA Surg. 2019; 154(6):551-552.
  • 3. Nano M. Technique for inguinal hernia repair in the elderly patient. Am J Surg. 1983; 146(3):373-5.
  • 4. Tonelli, C., Ringhouse, B., Bunn, C. et al. The Impact of the Aging Population on Surgical Diseases. Curr Geri Rep ,2021; 10:21–31.
  • 5. Kraft BM, Kolb H, Kuckuk B, Haaga S, Leibl BJ, Kraft K, Bittner R. Diagnosis and classification of inguinal hernias. Surg En-dosc. 2003; 17(12):2021-4.
  • 6. van Veenendaal N, Simons M, Hope W, Tumtavitikul S, Bon-jer J; HerniaSurge Group. Consensus on international guide-lines for management of groin hernias. Surg Endosc. 2020; 34(6):2359-2377.
  • 7. Miserez M, Peeters E, Aufenacker T, Bouillot JL, Campanelli G, Conze J, et al Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal her-nia in adult patients. Hernia. 2014; 18(2):151-63.
  • 8. Yang W, Tao Z, Chen H, Li Q, Chu PG, Yen Y, et al. Amyand's hernia in elderly patients: diagnostic, anesthetic, and perio-perative considerations. J Invest Surg. 2009; 22(6):426-9.
  • 9. Kartal M. İleri Yaşlı Hastalarda (85 yaş ve üzeri) İnkarsere İnguinal Herni Cerrahisi Deneyimlerimiz. Osmangazi Tıp Der-gisi. 2021; 43(5):485-9.
  • 10. Abebe MS, Tareke AA, Alem A, Debebe W, Beyene A. Worldwide magnitude of inguinal hernia: Systematic review and meta-analysis of population-based studies. SAGE Open Med. 2022; 10:20503121221139150.
  • 11. Bal J, Ilonzo N, Spencer P, Hyakutake M, Leitman IM. Loss of independence after emergency inguinal hernia repair in el-derly patients: How aggressive should we be? Am J Surg. 2022; 223(2):370-374.
  • 12. Işıl RG, Yazıcı P, Demir U, Kaya C, Bostancı Ö, İdiz UO, et al. Approach to inguinal hernia in high-risk geriatric patients: Should it be elective or emergent? Ulus Travma Acil Cerrahi Dergisi. 2017; 23(2):122-127.
  • 13. Rørbaek-Madsen M. Herniorrhaphy in patients aged 80 years or more. A prospective analysis of morbidity and mortality. Eur J Surg. 1992; 158(11-12):591-4.
  • 14. Pokorny H, Klingler A, Schmid T, Fortelny R, Hollinsky C, Kawji R, et al. Recurrence and complications after laparos-copic versus open inguinal hernia repair: results of a pros-pective randomized multicenter trial. Hernia. 2008; 12(4):385-9.
  • 15. Ceresoli M, Carissimi F, Nigro A, Fransvea P, Lepre L, Braga M, et al List of Elderly Risk Assessment and Surgical Outcome (ERASO) Collaborative Study Group endorsed by SICUT, ACOI, SICG, SICE, and Italian Chapter of WSES. Emergency hernia repair in the elderly: multivariate analysis of morbidity and mortality from an Italian registry. Hernia. 2022; 26(1):165-175.
  • 16. Piltcher-da-Silva R, Sasaki VL, Bettini LFC, Soares PSM, Va-landro IG, Cavazzola LT. Outcomes of Emergency Groin Her-nia Repair in the Elderly: A Systematic Review. J Abdom Wall Surg. 2023; 2:11246.
There are 16 citations in total.

Details

Primary Language English
Subjects General Surgery
Journal Section Research Article
Authors

Fırat Erkmen 0000-0001-7102-8973

Mehmet Gümer 0000-0003-2097-9191

Early Pub Date June 10, 2025
Publication Date June 27, 2025
Submission Date March 12, 2025
Acceptance Date May 22, 2025
Published in Issue Year 2025 Volume: 22 Issue: 2

Cite

Vancouver Erkmen F, Gümer M. Safety of Elective Inguinal Hernia Repair in the Geriatric Population: A Retrospective Analysis. Harran Üniversitesi Tıp Fakültesi Dergisi. 2025;22(2):313-6.