The incidence and analysis of ipsilateral occult hernia in patients undergoing hernia repair: a single institution retrospective study of 1066 patients

Abstract

Background Misdiagnosis or failure to intraoperatively detect occult hernia in the inguinal region can lead to the recurrence of postoperative hernia and the appearance of local pain symptoms, which affect the patient’s quality of life and make it difficult to reperform hernia repair. Methods This study included 1066 inguinal hernia patients who underwent surgical treatment at Shanghai Tongren Hospital between January 2016 and October 2018 to investigate ipsilateral occult hernia epidemiology, to analyze the characteristics of ipsilateral occult hernias with regards to patient age, gender, classification and anatomical site, and to explore the superiority and inferiority of the expert hernia surgeons/ non-expert hernia surgeons group and of operation methods in finding occult inguinal hernias. Results The incidence of ipsilateral occult hernia in the surgical population was 8.26%. Ipsilateral occult hernia included indirect inguinal hernia, direct inguinal hernia, femoral hernia, obturator hernia, and spigelian hernia, among which the highest incidence was direct inguinal hernia (4.11%), followed by indirect inguinal hernia (2.45%). There was no difference in the incidence of ipsilateral occult hernia between males and females, but there were significant differences in the incidence of ipsilateral occult hernia, which decreased gradually with increasing age in patients younger than 70 years-old; there was no difference in incidence in patients over 70 years-old. There were significant differences in the incidence of ipsilateral occult hernia in the bilateral inguinal region between direct and femoral hernia, with the higher incidence found on the right side; in contrast, there was no difference in the incidence of indirect inguinal hernia in the bilateral inguinal region. There was no difference in the ability of experienced physicians to detect ipsilateral occult inguinal hernias, either professionally or by surgery. Conclusions Ipsilateral occult inguinal hernia has a higher incidence in patients with inguinal hernia, especially older patients; therefore, it is necessary for experienced surgeons to carefully detect for possible occult hernia during the operation and in elderly patients.

Occult hernia: role of laparoscopy in detecting the unseen

“…The 2018 international consensus guidelines for the diagnosis and treatment of inguinal hernia by the HerniaSurge group indicate that occult hernia is an asymptomatic hernia not detectable by physical examination. 3 The current guidelines do not provide a specific therapeutic approach for this type of hernias. 1,2 Most patients with symptomatic inguinal hernias do not require preoperative imaging because physical examination findings are diagnostic.…”

How Often Occult Inguinal or Spigelian Hernias Detected During Laparoscopy of Other Reasons Are Later Operated?

“…Approximately 12,000 inguinal herniorraphies are performed each year in Finland, over 80,000 operations in England and over 800,000 in the United States 8–10. The frequency of incipient inguinal or Spigelian hernias is unknown in asymptomatic healthy adult population, but occult contralateral hernias are common in laparoscopic hernioplasty or imaging studies of patients with inguinal pain 1–6. Occult inguinal or Spigelian hernias found incidentally during laparoscopy of upper abdominal diseases is different patient population from the occult contralateral hernias found during laparoscopic inguinal hernia repair.…”

“…Most laparoscopic and imaging studies report high incidence of contralateral occult hernias (10% to 20%), when true inguinal hernia is repaired. There is controversy about whether or not these incidental hernias should be repaired 1–4. Modern imaging studies have become more accurate in the diagnosis of abdominal and inguinal pathologies, but magnetic resonance imaging or computer tomography (CT) may not detect small asymptomatic inguinal hernias 5,6.…”

“…There is controversy about whether or not these incidental hernias should be repaired. [1][2][3][4] Modern imaging studies have become more accurate in the diagnosis of abdominal and inguinal pathologies, but magnetic resonance imaging or computer tomography (CT) may not detect small asymptomatic inguinal hernias. 5,6 Therefore, diagnostic laparoscopy remains the most effective tool to diagnose these occult hernias.…”

Difficulties in Diagnosing Extraperitoneal Ureteroinguinal Hernias: A Review of the Literature and Clinical Experience of a Rare Encounter in Acute Surgical Care Settings

“…Studies report around 95% of patients presenting to primary care with inguinal hernias to be men, with a high incidence of over 75 year olds [ 10 ] at around 20 per thousand person–years [ 11 ]. Even though surgeons encounter many cases of inguinal hernias that are easily diagnosed based on the clinical picture and clinical experience, the rate of misdiagnosed or undiagnosed inguinal hernias can go up to 8%, as some studies report [ 12 , 13 ]. Overall, the surgery for repairing inguinal hernias is considered one of the most common procedures in the surgical field [ 14 , 15 , 16 ], where available data shows 10 surgeries performed per 100,000 people in the U.K., and up to a higher number of 28 surgeries performed per 100,000 people in the U.S. [ 7 ].…”