Reparation of groin hernias

Abstract

Introduction: Inguinal and femoral hernias may occur in the groin region in case of protrusion of the contents of the abdominal cavity through the transverse fascia above the inguinal ligament, or below, through the femoral canal. Reparation of groin hernias is one of the most frequently operation performed at general surgery. Objective: To show the frequency of groin hernias subtypes and frequency of different surgical techniques used in reparation during a three-year period. Patients and methods: Retrospective analysis included data obtained from surgical operating protocols and medical histories of patients operated elective or urgent, at the surgical ward of the General Hospital Kikinda, because of groin hernias in the period 1st January 2013 - 31st December 2015. For statistical analysis we used Pearson's χ2-test. Results: 377 patients were operated (340 men vs. 37 women; χ2=243.52; p<0.001), mean age 57.18±17.27 years (4-89); 358 (94.96%) patients had inguinal and 19 (5.04%) patients had femoral hernia (χ2=304.84; p<0.001). An inguinal hernia was more frequent in men (333 men vs. 25 women; χ2=264.98; p<0.001), while in femoral hernia there was no statistical significance between the genders (7 men vs. 12 women; χ2=1.32; p>0.05). 333(97.94%) men had inguinal hernia surgery; 7 (2.06%) men had femoral hernia surgery (χ2=312.58; p<0.001). 25 (67.57%) women had inguinal hernia surgery; 12 (32.43%) women had femoral hernia surgery (χ2=4.56; p<0.05). 388 hernioplasties were done - 369 (95.10%) inguinal and 19 (4.90%) femoral (χ2=315.72; p<0.001). 347 (96.93%) patients had unilateral inguinal hernioplasty (203 right and 144 left) and 11 (3.07%) patients had bilateral inguinal hernioplasty (χ2=162.11; p<0.001). 347(94.04%) inguinal hernias were primary and 22 (5.26%) inguinal hernias were recurrent. 13(3.52%) inguinal hernias were incarcerated. Of all inguinal hernias 127 (34.42%) were direct, 201 (54.47%) were indirect and 41 (11.11%) were direct and indirect (χ2=104.26; p<0.001). 15 (78.95%) patients had femoral hernia surgery on the right side and 4 (21.05%) patients had femoral hernia surgery on the left side (χ2=6.36; p<0.05). All femoral hernias were primary. 6 (31.58%) patients had incarcerated femoral hernias. Incarcerated femoral hernias were more frequent than incarcerated inguinal hernias (χ2=254.31; p<0.001). 347(92.05%) patients were operated in general anaesthesia (χ2=587.85; p<0.001). 371 tension-free hernioplasties and 17 tension hernioplasties (95.62% vs. 4.38%; χ2=322.98; p<0.001) were done. The mesh sized 6x11cm was most frequently used (χ2=175.26; p<0.001). 352 (95.39%) inguinal hernioplasties were done by Lichtenstein technique. 16 (84.21%) femoral hernioplasties were done by Rives technique. Bowel resection in incarcerated hernias was performed in1 of 13(7.69%) patients with inguinal hernias, and in 3 of 6 (50.0%) patients with femoral hernias (χ2=19.43; p<0.001). Conclusion: Groin hernias are more common in men. Inguinal hernias are more frequent than femoral in both genders. Inguinal and femoral hernias are more common on the right side. The most common is an indirect inguinal hernia. The operation is usually performed in general anaesthesia. The tension-free techniques with synthetic 6x11cm mesh are predominantly used. Lichtenstein hernioplasty is predominantly used for inguinal hernias. Rives hernioplasty is predominantly used for femoral hernias. Incarcerated inguinal hernias are rare. Incarcerated femoral hernias are more common and often need bowel resection.