Objective To determine age- and sex-specific incidence rates of inguinal hernia repairs (IHR) in a well defined USA population and examine trends over time. Summary Background Data IHR represent a substantial burden to the US healthcare system. An up to date appraisal will identify future healthcare needs. Methods A retrospective review of all IHR performed on adult residents of Olmsted County, MN from 1989 to 2008 was performed. Cases were ascertained through the Rochester Epidemiology Project, a record-linkage system with >97% population coverage. Incidence rates were calculated by using incident cases as the numerator and population counts from the census as the denominator. Trends over time were evaluated using Poisson regression. Results During the study period, a total of 4,026 IHR were performed on 3,599 unique adults. Incidence rates per 100,000 person-years were greater for men: 368 vs 44 for women, and increased with age: from 194 to 648 in men, and from 28 to 108 in women between 30 and 70 years of age. Initial, unilateral IHR comprised 74% of all IHR types. The life-long cumulative incidence of an initial, unilateral or bilateral IHR in adulthood was 42.5% in men and 5.8% in women. Over time (from 1989 to 2008), the incidence of initial, unilateral IHR in men decreased from 474 to 373 (relative reduction, RR=21%). Bilateral IHR increased from 42 to 71 (relative increase=70%), contralateral metachronous IHR decreased from 29 to 11 (RR=62%), and recurrent IHR decreased from 66 to 26 (RR=61%), all changes p<0.001. Conclusions IHR are common, their incidence varies greatly by age and sex, and has decreased substantially over time in Olmsted County, Minnesota.

Purpose The relationship between body mass index (BMI) and the risk of inguinal hernia development is unclear. To explore the relationship, we determined whether the incidence of inguinal hernia repairs (IHR) varied across patients in different BMI categories. Study Design A population-based incidence study was undertaken. We reviewed all IHR performed on adult residents of Olmsted County, MN from 2004 to 2008. Cases were ascertained through the Rochester Epidemiology Project, a records-linkage system with more than 97% population coverage. Results During the study period, a total of 1,168 IHR were performed on 879 men and 107 women. The median BMI of the cohort was 26.7 kg/m2 (range 14.9 – 58.1; interquartile range 23.9 – 28.9). Incidence rates varied significantly as a function of BMI (p<0.001). Rates were highest among men who were either normal weight or overweight (419.8 and 421.1 per 100,000 person years for BMI<25 and BMI 25–29.9, respectively), and lowest for obese and morbidly obese men (273.5 and 99.4 per 100,000 person years for BMI 30–34.9 and BMI ≥35, respectively). Findings were similar across all age categories and in patients who had an IHR that was initial or recurrent, direct or indirect, and unilateral or bilateral. Conclusions The incidence of IHR decreased as BMI increased. Obese and morbidly obese patients had a lower incidence of IHR than those who were normal weight or overweight. The causal mechanisms leading to such a relationship are unclear and warrant further study.

Background Evidence suggests that watchful waiting of inguinal hernias (IH) is safe because the risk of acute strangulation requiring an emergent repair is low. However, population-based incidence rates are lacking, and it is unknown whether the incidence of emergent inguinal hernia repairs (IHR) has changed over time. Study design A retrospective review of all IHR performed on adult residents of Olmsted County, Minnesota from 1989 to 2008 was performed using the Rochester epidemiology project, a record-linkage system that covers more than 97 % of the population (2010 US Census = 146,466). Incidence rates/100,000 person-years were calculated, and trends over time were evaluated using Poisson regression. Results A total of 4,026 IHR were performed on 3,599 patients; 136 repairs (3.8 %) were emergent. Of these, 19 patients (14 %) had bowel resection and three (2 %) died within 30 days of the repair. Rates/100,000 person-years yielded an overall incidence of 7.6 for emergent IHR and 200.0 for elective IHR. Emergent IHR rates increased with age. Overall emergent IHR rates declined from 18.2 to 12.4 in men and from 6.4 to 2.4 in women from 1989 to 2008 (p > 0.05). Older age, obesity, a high ASA risk score, a femoral and/or a recurrent hernia were more likely to be associated with an emergent IHR (all p ≤ 0.05). Conclusion The incidence of emergent IHR is low. This risk has decreased over the past 20 years. However, patients who are either ≥70 years old, obese, with a high ASA score, or with a femoral or recurrent hernias are more likely to require an emergent IHR and could benefit from elective operative intervention if deemed adequate surgical candidates.

Background The use of inguinal hernia repair techniques in the community setting is poorly understood. Methods A retrospective review of all inguinal hernia repairs performed on adult residents of Olmsted County, MN, from 1989 to 2008 was performed through the Rochester Epidemiology Project. Results A total of 4,433 inguinal hernia repairs among 3,489 individuals were reviewed. Non–mesh-based repairs predominated in the late 1980s (94% in 1989), declined throughout the 1990s (40% in 1996), and are rarely used nowadays (4% in 2008). Open mesh-based repairs comprised 21% in 1990, peaked in 2001 with 72%, and declined to 55% in 2008. The adoption of laparoscopic repairs began in 1992 (6%) and has increased steadily to 41% in 2008 (P < .001). Conclusions Although non–mesh-based repairs, once the predominant method, have been supplanted by open mesh-based techniques, nowadays the use of laparoscopic inguinal hernia repair techniques has increased substantially to nearly equal that of open mesh-based techniques.

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