Occult hernia: role of laparoscopy in detecting the unseen

Abstract

Background: OH (occult hernias) refer to those hernias which are not evident on clinical examination, but which are noted either on surgical exploration or on good quality pre-operative imaging. Identifying them in day-to-day practice is of immense importance in view of unexplained and undiagnosed symptomatology, post-operative recurrences and cost effectiveness. The main objective of this paper is to study the incidence of occult hernias diagnosed intra-operatively during laparoscopic groin hernia surgery.Methods: In this retrospective study, we identified 723 patients who underwent laparoscopic repair of groin hernia in our institute by a single surgeon, from 2008 to 2021. OH were found in 120 patients, all during totally extraperitoneal approach (TEPA) and none during transabdominal pre-peritoneal approach (TAPP). The age range of these 120 patients was 22 to 83 years (mean: 60.7 years with SD: ±12.5 years). The patients were also analysed for sex, type of OH, side of OH and post-operative outcomes.Results: Incidence of OH in our study was 16.59% (120 out of 723 patients). OH were found in both male as well as female patients. These comprised of unilateral and bilateral OH. Patients with unilateral OH heavily outnumbered those with bilateral OH (n=117 vs. 3). There were 3 different types of OH in our study-inguinal, femoral and spigelian. The maximum number of cases were of inguinal OH (n=115). Among inguinal OH, patients with direct OH outnumbered those with indirect OH (n=73 vs. 40).Conclusions: Awareness about OH as an entity is important, as their identification and concurrent repair possibly spares the patient another surgical intervention at a later date.