Direct and Recurrent Inguinal Hernias Are Associated with Ventral Hernia Repair: A Database Study

Abstract

In their well-designed presentation, Henriksen et al. [1] use a massive sample of over 92,000 patients from the Danish Hernia Database to explore the association between inguinal and ventral hernias. The authors find that on multivariate analysis direct and recurrent inguinal hernias are associated with ventral hernias. The odds ratios are statistically significant, but the effect sizes are modest and range from 1.28 to 1.76. In other words, even if the risk for a ventral hernia increases in the presence of an inguinal hernia, the increase is small, as shown by the fact that less than 1 % of inguinal hernia patients were found to have ventral hernias too. Readers should note that the Danish Hernia Database includes only hernias that were treated surgically. Therefore, this study reports on the association between inguinal and ventral hernias, requiring repair; the true association for all hernias in not known. Another puzzling piece of information is the timing of hernia repair as reported in this study. Only 8.7 % of ventral hernias were repaired before the inguinal hernia was repaired. It almost seems that there is a biologic clock by which the inguinal floor gives up first; then the abdominal wall follows. One could assume that an inguinal hernia is a forewarning of future anatomical defects. In any case, it only makes good common sense to assume that a disease of collagen structure, as is hernia, will not be localized only to a certain area of the body. Using the scientific lenses of this study, investigators should look into other possible associations between inguinal hernia and collagen abnormalities. Preventive methods could then be developed and additional surgical interventions could be planned. Until then, the conclusions of this study are interesting, but I would not know how to use them. The authors have provided us with great food for thought. Any plans for the next step?