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Emergency Femoral Hernia Repair A Study Based on a National Register
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
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2009 (English)In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 249, no 4, 672-676 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To describe the characteristics of femoral hernias and outcome of femoral repairs, with special emphasis on emergency operations. Background: Femoral hernias account for 2% to 4% of all groin hernias. However, the lack of large-scale studies has made it impossible to draw conclusions regarding the best management of these hernias. Methods: The study is based on patients 15 years or older who underwent groin hernia repair 1992 to 2006 at units participating in the Swedish Hernia Register. Results: Three thousand nine hundred eighty femoral hernia repairs were registered, 1490 on men and 2490 on women: 1430 (35.9%) patients underwent emergency surgery compared with 4.9% of the 138,309 patients with inguinal hernias. Bowel resection was performed in 22.7% (325) of emergent femoral repairs and 5.4% (363) of emergent inguinal repairs. Women had a substantial over risk for undergoing emergency femoral surgery compared with men (40.6% vs. 28.1%). An emergency femoral hernia operation was associated with a 10-fold increased mortality risk, whereas the risk for an elective repair did not exceed that of the general population. In elective femoral hernias, laparoscopic (hazard ratio, 0.31; 95% confidence interval, 0.15-0.67) and open preperitoneal mesh (hazard ratio, 0.28; confidence interval, 0.12-0.65) techniques resulted in fewer re-operations than suture repairs. Conclusions: Femoral hernias are more common in women and lead to a substantial over risk for an emergency operation, and consequently, a higher rate of bowel resection and mortality. Femoral hernias should be operate with high priority to avoid incarceration and be repaired with a mesh.

Place, publisher, year, edition, pages
2009. Vol. 249, no 4, 672-676 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-129143DOI: 10.1097/SLA.0b013e31819ed943ISI: 000264899100022OAI: oai:DiVA.org:uu-129143DiVA: diva2:337752
Available from: 2010-08-09 Created: 2010-08-05 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Femoral and Inguinal Hernia: How to Minimize Adverse Outcomes Following Repair
Open this publication in new window or tab >>Femoral and Inguinal Hernia: How to Minimize Adverse Outcomes Following Repair
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Groin hernia is common, and each year 200 repairs per 100 000 adult inhabitants are performed in Sweden. Groin hernias are either inguinal or femoral (2-4%). Elective repair is not associated with an excess mortality, but adverse outcomes include recurrence and long-term pain. Emergency procedures have a 4% mortality rate with an increased risk for bowel resection and postoperative complications. The aim of this thesis was to identify risk factors for adverse outcomes and to propose measures to improve groin hernia treatment.

Twenty-three per cent of female hernias were femoral. Thirty-six per cent of femoral hernias, and 5% of inguinal hernias, have emergency procedures. Females (OR 1.47) and patients above 65 years-of-age (OR 2.24) were at higher risk for emergency repair. Bowel resection was performed in 23% of emergency femoral repairs, and the 30-day mortality was 10 times that of an age- and gender-matched population. The majority of emergency patients were unaware of their hernia, and one third had previously had no groin symptoms.

Femoral repairs were at larger risk for recurrence than inguinal repairs. The surgical techniques with least risk for recurrence were preperitoneal mesh repairs (open HR 0.28, and laparoscopic HR 0.31). Long-term pain was present in 24% of femoral hernia patients, of whom 5.5% described pain interfering with daily activities. The only factor predicting the risk for long-term pain was pain preoperatively. Pain decreased with time.

In a randomized study on inguinal hernia, TEP resulted in less pain six weeks after surgery than Lichtenstein repair performed under local anesthesia (LLA). TEP patients were to a larger extent able to perform sporting activities. No difference was seen in intra-operative complications.

Femoral hernias should be given high priority for repair and preperitoneal techniques should be used. Earlier diagnosis, in the elective setting, is probably difficult to attain. Heightened awareness in the emergency department is required. TEP is safe, and results in less pain than LLA six weeks after surgery. A widening of indications for TEP in primary inguinal hernia repair is justifiable.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Uppsaliensis, 2011. 57 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 728
Keyword
femoral hernia, inguinal hernia, adverse outcome, complication, recurrence, chronic pain, long-term pain, emergency, mortality, TEP, Lichtenstein, local anesthesia
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-162203 (URN)978-91-554-8236-7 (ISBN)
Public defence
2012-01-13, Enghoffsalen, Ing 50, Akademiska Sjukhuset, Uppsala, 13:15 (English)
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Available from: 2011-12-20 Created: 2011-11-26 Last updated: 2012-01-03Bibliographically approved

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