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Risk Factors and Surgical Treatment Methods in Femoral Hernia

Year 2020, , 175 - 179, 12.07.2020
https://doi.org/10.30565/medalanya.696769

Abstract

Aim: Femoral hernias are more common in the right groin and in the female population. Elective hernia surgery after diagnosis is the most suitable option for femoral hernias, due to fewer complications and shorter length of hospitalization. In this study, we analysed the factors affecting clinical outcomes in patients undergoing urgent or elective early surgery, due to femoral hernia.

Materials and methods: In this retrospective study, all elective and urgent femoral hernias that were operated between January 2017 and January 2020 were analysed. Routine imaging tests were not applied to the patients and ultrasonography (USG) was applied in the presence of clinical suspicion. 

Results: 38 femoral hernia patients were operated on during the 3 years observation period. According to the type of surgery, 30 patients underwent hernia repair with mesh and 8 patients underwent suture repair. Of the 28 patients operated electively, 5 were male and 23 were female. 17 of the patients were right and 11 were left femoral hernia. Of the 10 patients who were operated urgently due to strangulation or incarceration, 4 were male and 6 were female. 7 of the patients were right and 3 were left femoral hernia. 3 of the urgently operated patients underwent intestinal resection due to strangulation.

Conclusion: Femoral hernias were more common in women and especially in the right side, and emergent femoral hernia surgery resulted in more intestinal resection and longer patient hospitalization. In particular, we think that the application of USG with physical examination in women will increase the diagnosis rates of femoral hernias. In addition, we think that the diagnosis of preoperative femoral hernia will decrease recurrence rates by choosing the right surgical technique.

References

  • 1. 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. doi: 10.1007/s10029-009-0529-7. 
  • 2. 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 hernia in adult patients.  Hernia. 2014;18(2):151-63. doi: 10.1007/s10029-014-1236-6. 
  • 3. Primatesta P, Goldacre MJ. Inguinal hernia repair: incidence of elective and emergency surgery, readmission and mortality. Int J Epidemiol. 1996;25(4):835-39. doi: 10.1093/ije/25.4.835. 
  • 4. Hernández-Irizarry R, Zendejas B, Ramirez T, Moreno M, Ali SM, Lohse CM et al. Trends in emergent inguinal hernia surgery in Olmsted County, MN: a population-based study. Hernia. 2012;16(4):397-403. doi: 10.1007/s10029-012-0926-1. 
  • 5. International guidelines for groin hernia management. Hernia. 2018;22(1):1-165. doi: 10.1007/s10029-017-1668-x. 
  • 6. Burcharth J, Pedersen M, Bisgaard T, Pedersen C, Rosenberg J. Nationwide prevalence of groin hernia repair. PLoS One. 2013;8(1):e54367. doi: 10.1371/journal.pone.0054367. 
  • 7. Quintas ML, Rodrigues CJ, Yoo JH, Rodrigues Junior AJ. Age related changes in the elastic fiber system of the interfoveolar ligament. Rev Hosp Clin Fac Med Sao Paulo. 2000;55(3):83-6. doi: 10.1590/s0041-87812000000300003. 
  • 8. Ku JH, Jeong CW, Park YH, Cho MC, Kwak C, Kim HH. Nerve-sparing procedure in radical prostatectomy: a risk factor for hernia repair following open retropubic, pure laparoscopic and robot-assisted laparoscopic procedures. Scand J Urol Nephrol. 2011;45(3):164-70. doi: 10.3109/00365599.2010.544674. 
  • 9. Lughezzani G, Sun M, Perrotte P, Alasker A, Jeldres C, Isbarn H et al. Comparative study of inguinal hernia repair rates after radical prostatectomy or external beam radiotherapy. Int J Radiat Oncol Biol Phys. 2010;78(5):1307-13. doi: 10.1016/j.ijrobp.2009.09.065. 
  • 10. Sun M, Lughezzani G, Alasker A, Isbarn H, Jeldres C, Shariat SF et al.Comparative study of inguinal hernia repair after radical prostatectomy, prostate biopsy, transurethral resection of the prostate or pelvic lymph node dissection. J Urol. 2010;183(3):970-75. doi: 10.1016/j.juro.2009.11.036. 
  • 11. Yoshimine S, Miyajima A, Nakagawa K, Ide H, Kikuchi E, Oya M. Extraperitoneal approach induces postoperative inguinal hernia compared with transperitoneal approach after laparoscopic radical prostatectomy. Jpn J Clin Oncol. 2010;40(4):349-52. doi: 10.1093/jjco/hyp172. 
  • 12. Sekita N, Suzuki H, Kamijima S, Chin K, Fujimura M, Mikami K et al. Incidence of inguinal hernia after prostate surgery: open radical retropubic prostatectomy versus open simple prostatectomy versus transurethral resection of the prostate. Int J Urol. 2009;16(1):110-3. doi: 10.1111/j.1442-2042.2008.02190.x. 
  • 13. Koie T, Yoneyama T, Kamimura N, Imai A, Okamoto A, Ohyama C. Frequency of postoperative inguinal hernia after endoscope-assisted mini-laparotomy and conventional retropubic radical prostatectomies. Int J Urol. 2008;15(3):226-9. doi: 10.1111/j.1442-2042.2007.01983.x.
  • 14. Bittner R, Arregui ME, Bisgaard T, Dudai M, Ferzli GS, Fitzgibbons RJ et al. Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia [International Endohernia Society (IEHS)]. Surg Endosc. 2011;25(9):2773-843. doi: 10.1007/s00464-011-1799-6. 
  • 15. Poelman MM, van den Heuvel B, Deelder JD, Abis GS, Beudeker N, Bittner RR et al. EAES Consensus Development Conference on endoscopic repair of groin hernias. Surg Endosc. 2013;27(10):3505-19. doi: 10.1007/s00464-013-3001-9. 
  • 16. Tran H, Tran K, Turingan I, Zajkowska M, Lam V, Hawthorne W. Single-incision laparoscopic inguinal herniorraphy with telescopic extraperitoneal dissection: technical aspects and potential benefits. Hernia. 2015;19(3):407-16. doi: 10.1007/s10029-015-1349-6. 
  • 17. Tschuor C, Metzger J, Clavien PA, Vonlanthen R, Lehmann K. Inguinal hernia repair in Switzerland. Hernia. 2015;19(5):741-5. doi: 10.1007/s10029-015-1385-2.  18. Bay-Nielsen M, Kehlet H, Strand L, Malmstrøm J, Andersen FH, Wara P et al. Quality assessment of 26,304 herniorrhaphies in Denmark: a prospective nationwide study. Lancet. 2001;358(9288):1124-8. doi: 10.1016/S0140-6736(01)06251-1. 
  • 19. Ohene-Yeboah M, Abantanga F, Oppong J, Togbe B, Nimako B, Amoah M et al. Some aspects of the epidemiology of external hernias in Kumasi, Ghana. Hernia. 2009;13(5):529-32. doi: 10.1007/s10029-009-0491-4.
  • 20. Abe T, Shinohara N, Harabayashi T, Sazawa A, Suzuki S, Kawarada Y et al. Postoperative inguinal hernia after radical prostatectomy for prostate cancer. Urology. 2007;69(2):326-9. doi: 10.1016/j.urology.2006.09.043.
  • 21. Tsai PJ, Yu CC, Lee YH, Huang JK. Inguinal hernia after radical retropubic prostatectomy--experience of Kaohsiung Veterans General Hospital. J Chin Med Assoc. 2004;67(3):141-4. PMID: 15181967.
  • 22. Ichioka K, Yoshimura K, Utsunomiya N, Ueda N, Matsui Y, Terai A et al. High incidence of inguinal hernia after radical retropubic prostatectomy. Urology. 2004;63(2):278-81. doi: 10.1016/j.urology.2003.09.038. 
  • 23. Klinge U, Klosterhalfen B. Modified classification of surgical meshes for hernia repair based on the analyses of 1,000 explanted meshes. Hernia. 2012;16(3):251-8. doi: 10.1007/s10029-012-0913-6. 
  • 24. Klosterhalfen B, Klinge U. Retrieval study at 623 human mesh explants made of polypropylene--impact of mesh class and indication for mesh removal on tissue reaction. J Biomed Mater Res B Appl Biomater. 2013;101(8):1393-9. doi: 10.1002/jbm.b.32958. 
  • 25. Silvestre AC, de Mathia GB, Fagundes DJ, Medeiros LR, Rosa MI. Shrinkage evaluation of heavyweight and lightweight polypropylene meshes in inguinal hernia repair: a randomized controlled trial. Hernia. 2011;15(6):629-34. doi: 10.1007/s10029-011-0853-6. 
  • 26. Ciritsis A, Hansen NL, Barabasch A, Kuehnert N, Otto J, Conze J et al. Time-dependent changes of magnetic resonance imaging-visible mesh implants in patients. Invest Radiol. 2014;49(7):439-44. doi: 10.1097/RLI.0000000000000051. 
  • 27. Goldet G, Howick J. Understanding GRADE: an introduction. J Evid Based Med. 2013;6(1):50-54. doi: 10.1111/jebm.12018.

Femoral Hernide Risk Faktörleri ve Cerrahi Tedavi Yöntemleri

Year 2020, , 175 - 179, 12.07.2020
https://doi.org/10.30565/medalanya.696769

Abstract

Amaç: Femoral fıtıklar sağ kasıkta ve kadınlarda daha sık görülürler. Daha az komplikasyon ve yatış süresi sebebiyle femoral fıtık olgularında teşhis sonrası erken elektif fıtık cerrahisi en uygun seçenektir. Bu çalışmada femoral fıtık nedeniyle acil ya da elektif erken ameliyat edilen hastalarda klinik sonuçlara etki eden faktörleri araştırdık 

Gereç ve yöntemler: Bu retrospektif çalışmada Ocak 2017-Ocak 2020 tarihleri arasında ameliyat edilen femoral fıtıklar incelendi. Hastalara rutin pre-op görüntüleme yöntemleri kullanılmamakla beraber klinik şüphe varlığında ultrasonografi (USG) uygulandı. 

Bulgular: 3 yıllık süre içinde 38 femoral fıtık hastası ameliyat edildi. Ameliyat tipi olarak 30 hastaya yamalı onarım, 8 hastaya yamasız onarım uygulandı. Elektif olarak ameliyat edilen 28 hastanın, 23’ü kadın 5’i erkekti. Hastaların 17’si sağ 11’i sol femoral fıtıktı. Acil olarak ameliyat edilen 10 hastanın 6’sı kadın, 4’ü erkekti. Hastaların 7’si sağ 3’ü sol femoral fıtıktı. Hastaların post-operatif ortalama hastane yatış süresi 143 saatti. Hastaların 3’üne strangülasyon nedeniyle bağırsak rezeksiyonu uygulandı.


Sonuç: Femoral fıtıklar kadınlarda ve özellikle sağ kasıkta daha sık saptanmış; acil uygulanan femoral fıtık cerrahisi daha fazla bağırsak rezeksiyonu ve uzun hasta yatış sürelerine yol açmıştır. Özellikle kadınlarda USG’nin fizik muayene ile birlikte uygulanması gözden kaçabilecek femoral fıtıkların teşhis oranlarını artıracağını düşünmekteyiz. Ayrıca preoperatif femoral fıtığın teşhisinin, doğru ameliyat tekniği seçimiyle nüks oranlarını da düşüreceğini düşünmekteyiz.

References

  • 1. 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. doi: 10.1007/s10029-009-0529-7. 
  • 2. 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 hernia in adult patients.  Hernia. 2014;18(2):151-63. doi: 10.1007/s10029-014-1236-6. 
  • 3. Primatesta P, Goldacre MJ. Inguinal hernia repair: incidence of elective and emergency surgery, readmission and mortality. Int J Epidemiol. 1996;25(4):835-39. doi: 10.1093/ije/25.4.835. 
  • 4. Hernández-Irizarry R, Zendejas B, Ramirez T, Moreno M, Ali SM, Lohse CM et al. Trends in emergent inguinal hernia surgery in Olmsted County, MN: a population-based study. Hernia. 2012;16(4):397-403. doi: 10.1007/s10029-012-0926-1. 
  • 5. International guidelines for groin hernia management. Hernia. 2018;22(1):1-165. doi: 10.1007/s10029-017-1668-x. 
  • 6. Burcharth J, Pedersen M, Bisgaard T, Pedersen C, Rosenberg J. Nationwide prevalence of groin hernia repair. PLoS One. 2013;8(1):e54367. doi: 10.1371/journal.pone.0054367. 
  • 7. Quintas ML, Rodrigues CJ, Yoo JH, Rodrigues Junior AJ. Age related changes in the elastic fiber system of the interfoveolar ligament. Rev Hosp Clin Fac Med Sao Paulo. 2000;55(3):83-6. doi: 10.1590/s0041-87812000000300003. 
  • 8. Ku JH, Jeong CW, Park YH, Cho MC, Kwak C, Kim HH. Nerve-sparing procedure in radical prostatectomy: a risk factor for hernia repair following open retropubic, pure laparoscopic and robot-assisted laparoscopic procedures. Scand J Urol Nephrol. 2011;45(3):164-70. doi: 10.3109/00365599.2010.544674. 
  • 9. Lughezzani G, Sun M, Perrotte P, Alasker A, Jeldres C, Isbarn H et al. Comparative study of inguinal hernia repair rates after radical prostatectomy or external beam radiotherapy. Int J Radiat Oncol Biol Phys. 2010;78(5):1307-13. doi: 10.1016/j.ijrobp.2009.09.065. 
  • 10. Sun M, Lughezzani G, Alasker A, Isbarn H, Jeldres C, Shariat SF et al.Comparative study of inguinal hernia repair after radical prostatectomy, prostate biopsy, transurethral resection of the prostate or pelvic lymph node dissection. J Urol. 2010;183(3):970-75. doi: 10.1016/j.juro.2009.11.036. 
  • 11. Yoshimine S, Miyajima A, Nakagawa K, Ide H, Kikuchi E, Oya M. Extraperitoneal approach induces postoperative inguinal hernia compared with transperitoneal approach after laparoscopic radical prostatectomy. Jpn J Clin Oncol. 2010;40(4):349-52. doi: 10.1093/jjco/hyp172. 
  • 12. Sekita N, Suzuki H, Kamijima S, Chin K, Fujimura M, Mikami K et al. Incidence of inguinal hernia after prostate surgery: open radical retropubic prostatectomy versus open simple prostatectomy versus transurethral resection of the prostate. Int J Urol. 2009;16(1):110-3. doi: 10.1111/j.1442-2042.2008.02190.x. 
  • 13. Koie T, Yoneyama T, Kamimura N, Imai A, Okamoto A, Ohyama C. Frequency of postoperative inguinal hernia after endoscope-assisted mini-laparotomy and conventional retropubic radical prostatectomies. Int J Urol. 2008;15(3):226-9. doi: 10.1111/j.1442-2042.2007.01983.x.
  • 14. Bittner R, Arregui ME, Bisgaard T, Dudai M, Ferzli GS, Fitzgibbons RJ et al. Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia [International Endohernia Society (IEHS)]. Surg Endosc. 2011;25(9):2773-843. doi: 10.1007/s00464-011-1799-6. 
  • 15. Poelman MM, van den Heuvel B, Deelder JD, Abis GS, Beudeker N, Bittner RR et al. EAES Consensus Development Conference on endoscopic repair of groin hernias. Surg Endosc. 2013;27(10):3505-19. doi: 10.1007/s00464-013-3001-9. 
  • 16. Tran H, Tran K, Turingan I, Zajkowska M, Lam V, Hawthorne W. Single-incision laparoscopic inguinal herniorraphy with telescopic extraperitoneal dissection: technical aspects and potential benefits. Hernia. 2015;19(3):407-16. doi: 10.1007/s10029-015-1349-6. 
  • 17. Tschuor C, Metzger J, Clavien PA, Vonlanthen R, Lehmann K. Inguinal hernia repair in Switzerland. Hernia. 2015;19(5):741-5. doi: 10.1007/s10029-015-1385-2.  18. Bay-Nielsen M, Kehlet H, Strand L, Malmstrøm J, Andersen FH, Wara P et al. Quality assessment of 26,304 herniorrhaphies in Denmark: a prospective nationwide study. Lancet. 2001;358(9288):1124-8. doi: 10.1016/S0140-6736(01)06251-1. 
  • 19. Ohene-Yeboah M, Abantanga F, Oppong J, Togbe B, Nimako B, Amoah M et al. Some aspects of the epidemiology of external hernias in Kumasi, Ghana. Hernia. 2009;13(5):529-32. doi: 10.1007/s10029-009-0491-4.
  • 20. Abe T, Shinohara N, Harabayashi T, Sazawa A, Suzuki S, Kawarada Y et al. Postoperative inguinal hernia after radical prostatectomy for prostate cancer. Urology. 2007;69(2):326-9. doi: 10.1016/j.urology.2006.09.043.
  • 21. Tsai PJ, Yu CC, Lee YH, Huang JK. Inguinal hernia after radical retropubic prostatectomy--experience of Kaohsiung Veterans General Hospital. J Chin Med Assoc. 2004;67(3):141-4. PMID: 15181967.
  • 22. Ichioka K, Yoshimura K, Utsunomiya N, Ueda N, Matsui Y, Terai A et al. High incidence of inguinal hernia after radical retropubic prostatectomy. Urology. 2004;63(2):278-81. doi: 10.1016/j.urology.2003.09.038. 
  • 23. Klinge U, Klosterhalfen B. Modified classification of surgical meshes for hernia repair based on the analyses of 1,000 explanted meshes. Hernia. 2012;16(3):251-8. doi: 10.1007/s10029-012-0913-6. 
  • 24. Klosterhalfen B, Klinge U. Retrieval study at 623 human mesh explants made of polypropylene--impact of mesh class and indication for mesh removal on tissue reaction. J Biomed Mater Res B Appl Biomater. 2013;101(8):1393-9. doi: 10.1002/jbm.b.32958. 
  • 25. Silvestre AC, de Mathia GB, Fagundes DJ, Medeiros LR, Rosa MI. Shrinkage evaluation of heavyweight and lightweight polypropylene meshes in inguinal hernia repair: a randomized controlled trial. Hernia. 2011;15(6):629-34. doi: 10.1007/s10029-011-0853-6. 
  • 26. Ciritsis A, Hansen NL, Barabasch A, Kuehnert N, Otto J, Conze J et al. Time-dependent changes of magnetic resonance imaging-visible mesh implants in patients. Invest Radiol. 2014;49(7):439-44. doi: 10.1097/RLI.0000000000000051. 
  • 27. Goldet G, Howick J. Understanding GRADE: an introduction. J Evid Based Med. 2013;6(1):50-54. doi: 10.1111/jebm.12018.
There are 26 citations in total.

Details

Primary Language English
Subjects Surgery
Journal Section Research Article
Authors

Salih Tosun This is me 0000-0002-5033-4477

Muhammet Ali Aydemir 0000-0003-0240-0924

Metin Leblebici 0000-0002-1403-7643

Özgür Ekinci This is me 0000-0002-2020-1913

Oktay Yener This is me 0000-0001-5488-4583

Orhan Alimoğlu 0000-0003-2130-2529

Publication Date July 12, 2020
Submission Date March 1, 2020
Acceptance Date April 11, 2020
Published in Issue Year 2020

Cite

Vancouver Tosun S, Aydemir MA, Leblebici M, Ekinci Ö, Yener O, Alimoğlu O. Risk Factors and Surgical Treatment Methods in Femoral Hernia. Acta Med. Alanya. 2020;4(2):175-9.

9705 

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