Femoral Hernia Research Articles

Trends in minimally invasive and open inguinal hernia repair: an analysis of ACGME general surgery case logs.

Groin hernia repair is one of the most commonly performed surgical procedures and is often performed by surgical interns and junior residents. While traditionally performed open, minimally invasive (MIS) groin hernia repair has become an increasingly popular approach. The purpose of this study was to determine the trends in MIS and open inguinal and femoral hernia repair in general surgery residency training over the past two decades. Accreditation Council for Graduate Medical Education (ACGME) national case log data of general surgery residents from 1999 through 2022 were reviewed. We collected means and standard deviations of open and MIS inguinal and femoral hernia repairs. Linear regression and ANOVA were used to identify trends in the average annual number of open and MIS hernia repairs logged by residents. Cases were distinguished between level of resident trainees: surgeon-chief (SC) and surgeon-junior (SJ). From July 1999 to June 2022, the average annual MIS inguinal and femoral hernia repairs logged by general surgery residents significantly increased, from 7.6 to 47.9 cases (p < 0.001), and the average annual open inguinal and femoral hernia repairs logged by general surgery residents significantly decreased, from 51.9 to 39.7 cases (p < 0.001). SJ resident results were consistent with this overall trend. For SC residents, the volume of both MIS and open hernia repairs significantly increased (p < 0.001). ACGME case log data indicates a trend of general surgery residents logging overall fewer numbers of open inguinal and femoral hernia repairs, and a larger proportion of open repairs by chief residents. This trend warrants attention and further study as it may represent a skill or knowledge gap with significant impact of surgical training.

The Role of MRI in Groin Pain Syndrome in Athletes.

Groin pain syndrome (GPS) is one of the most frequent injuries in competitive sports. Stresses generated in the lower limbs by quick turns and accelerations, such as in soccer, basketball or hockey, can produce localized regions of increased forces, resulting in anatomical lesions. The differential diagnoses are numerous and comprise articular, extra-articular, muscular, tendinous and visceral clinical conditions and a correct diagnosis is crucial if treatment is to be efficient. MRI is the gold standard of diagnostic techniques, especially when an alternative pathology needs to be excluded and/or other imaging techniques such as ultrasound or radiography do not lead to a diagnosis. This paper, based on the current literature, gives a comprehensive review of the anatomy of the pubic region and of the typical MRI findings in those affected by GPS. Many clinical conditions causing GPS can be investigated by MRI within appropriate protocols. However, MRI shows limits in reliability in the investigation of inguinal and femoral hernias and therefore is not the imaging technique of choice for studying these clinical conditions.

Global, regional, and national burden of inguinal, femoral, and abdominal hernias: a systematic analysis of prevalence, incidence, deaths, and DALYs with projections to 2030.

Hernias, particularly inguinal, femoral, and abdominal, present a global health challenge. While the Global Burden of Disease (GBD) study offers insights, systematic analyses of hernias remain limited. This research utilizes the GBD dataset to explore hernia implications, combining current statistics with 2030 projections and frontier analysis. We analyzed data from the 2019 GBD Study, focusing on hernia-related metrics: prevalence, incidence, deaths, and disability-adjusted life years (DALYs) across 204 countries, grouped into 21 GBD regions by the SDI (SDI). Data analysis incorporated relative change calculations, Annual Percentage Change (APC), Average Annual Percentage Change (AAPC), and Joinpoint Regression Analysis. The study also employed frontier analysis and the Bayesian Age-Period-Cohort model for trend prediction up to 2030. Analyses utilized R version 4.2.3. From 1990 to 2019, global hernia cases surged by 36%, reaching over 32.5 million, even as age-standardized rates declined. A similar pattern was seen in mortality and DALYs, with absolute figures rising but age-standardized rates decreasing. Gender data between 1990 and 2020 showed consistent male dominance in hernia prevalence, even as rates for both genders fell. Regionally, Andean Latin America had the highest prevalence, with Qatar and Bulgaria noting significant increases and decreases, respectively. Frontier analyses across 204 countries linked higher SDIs with reduced hernia prevalence. Yet, some high SDI countries, like Qatar and the UK, deviated unexpectedly. Predictions up to 2030 anticipate increasing hernia prevalence, predominantly in males, while death rates are expected to decline. DALYs, after declining, are stabilizing. Our analysis reveals a complex interplay between socio-demographic factors and hernia trends, emphasizing the need for targeted healthcare interventions. Despite advancements, vigilance and continuous research are essential for optimal hernia management globally.

Paraumbilical Hernia containing Appendiceal Inflammation: A Systematic Review

Background Usually umbilical hernia contains bowel loops and omentum. The diagnosis becomes even more challenging when they imitate strangulated umbilical hernia. An acutely inflamed appendix has been seen in the femoral and inguinal hernia but is rarely found in the paraumbilical hernia.&#x0D; Objectives To observe the symptoms, findings, and treatment process of cases of umbilical/ paraumbilical hernia in past literature and document a case report in the appendix within the paraumbilical hernia.&#x0D; Methods Literature has been searched with keywords and statements of umbilical hernia, appendix within the umbilical hernia, and paraumbilical hernia. Studies on appendix within paraumbilical hernia are scarce in the literature. Six studies from the past 12 years were included.&#x0D; Results There were six studies included. Pain, fever, vomiting, and swelling on the umbilicus were the common symptoms. No postoperative complication was seen.&#x0D; Conclusion Several factors can be responsible for umbilical hernia. A case report of a 50-years old male presented to Jinnah Hospital, Lahore with pain and umbilical swelling. Appendiceal inflammation was found in the hernia sac. Umbilical herniorrhaphy and appendectomy were done.&#x0D; Bangladesh Journal of Medical Science Vol. 23 No. 02 April’24 Page : 309-313

Incidence of groin hernia repairs in women and parity: a population-based cohort study among women born in Sweden between 1956 and 1983

IntroductionThe aim of this study was to evaluate the association between parity and the incidence rate of groin hernia repair in women.MethodThis study was based on two Swedish national registers, the Medical Birth Register (MBR), and the Swedish Hernia Register (SHR). The cohort constituted of women born between 1956 and 1983. Data on vaginal and cesarean deliveries were retrieved from the MBR. The birth and hernia registers were cross matched to identify hernia repairs carried out after deliveries.ResultsA total of 1,535,379 women were born between 1956 and 1983. Among these, 1,417,237 (92.3%) were registered for at least one birth. The incidence rate for Inguinal Hernia Repair (IHR) and Femoral Hernia Repair (FHR) was 10.7 per 100,000 person-year and 2.6 per 100,000 person-year, respectively. Compared with women registered for one delivery, the incidence rate ratio for IHR was 1.31 (95% Confidence Interval: 1.23–1.40) among women registered for two deliveries, 1.70 (1.58–1.82) among women registered for ≥ 3 deliveries. Additionally, the incidence rate ratios were higher 1.30 (1.14–1.49) and 1.70 (1.49–1.95) for FHR among women with two and ≥ 3 registered deliveries, respectively.ConclusionIn the present cohort, higher parity was associated with a higher incidence of inguinal as well as FHRs.

Laparoscopic Repair of Pediatric Femoral Hernias.

Background: Current rates of reported pediatric femoral hernias remain exceedingly low, with their incidence reported to be <1%. The mainstay of repair has traditionally been through an open approach, and pediatric surgeons remain reluctant to repair otherwise. Owing to its rarity, consensus regarding management remains absent. Because of this, we present a scoping review on the use of laparoscopy and minimally invasive techniques to repair pediatric femoral hernias. Methods: A scoping literature review was performed using PubMed, Embase, Scopus, and Web of Science for related articles (keywords). Full-text articles and abstracts were then reviewed for relevance using inclusion and exclusion criteria with data extracted from each piece. Results: The search identified 268 articles published from 1992 to 2023. Eleven articles met our inclusion criteria. After reviewing their content, a total of 87 patients were identified. Of these, 42 laparoscopic repairs were reported. Three primary laparoscopic surgical techniques were described, with no recurrence reported. Conclusion: Laparoscopy remains a viable tool in diagnosing and managing femoral hernias. Various technically feasible options for laparoscopy and minimally invasive techniques have been described with excellent results and limited recurrence. However, given the quality of the data, further studies are needed to investigate the long-term durability of such repairs.

An inguinal surprise: strangulated femoral hernia

Femoral hernias account for 2% to 4% of groin hernias, are more common in women, and are more appropriate to present with strangulation and require emergency surgery. This condition may lead to symptoms of bowel obstruction or strangulation and possible bowel resection-anastomosis. There are few reports of strangulated femoral hernia. Femoral hernias, often, are usually delegated to a secondary differential or if even rarer not considered at all during dubious presentations as groin swellings which are irreducible without the classical features which have usually been described in our surgical literatures, Inguinal being forefront for diagnosis. We herein present a 45-year-old female had come to the outpatient department at MVJ MC and RH with the complaints of swelling in the left groin for 5 years and pain for 8 days sudden onset with irreducibility, with no features of small bowel obstruction. She was diagnosed as having a left side obstructed inguinal hernia after appropriate radiological investigations and underwent inguinal exploration. Intraoperative diagnosis of left sided strangulated femoral hernia with omentum as its content was made. Omentectomy with herniorrhaphy was done and post-operative period was uneventful, and patient was discharged with regular follow up. 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 operated with high priority to avoid incarceration and be repaired with a mesh.

Femoral hernia in a 37-year-old male with COVID-19: a case report

Left sided femoral hernias in male patients are considered very uncommon, with femoral hernia’s accounting for less than 5% of abdominal wall hernias and 4:1 female to male ratio of occurrence. This case report will discuss a 37-year-old male who presented with a symptomatic incarcerated left femoral hernia following coughing in the setting of an active coronavirus 19 infection. Emergency surgical repair was pursued given incarcerated presentation of the femoral hernia. Whilst rare in men the diagnosis of femoral hernia is important for clinicians to consider ensuring appropriate surgical management is undertaken in a timely manner.

De Garengeot Hernia, an acute appendicitis in the right femoral hernia canal, and successful management with transabdominal closure and appendectomy: a case Report

Incarceration of the appendix within a femoral hernia is a rare condition of abdominal wall hernia about 0.1 to 0.5% in reported femoral hernia [1]. We report a case of a 56-year-old female whose appendix was trapped in the right femoral canal. There are few reports in the literature on entrapment of the appendix within a femoral hernia. The management of this condition includes antibiotics, drainage appendectomy, hernioplasty and mesh repair.

Management of groin hernias in emergency setting: differences in indications and outcomes between laparoscopic and open approach. A single-center retrospective experience

PurposeThe use of minimally invasive groin hernia repair techniques in an emergency setting is still debated and its widespread is limited.The aim of this study is to evaluate the safety and efficacy of the laparoscopic transabdominal preperitoneal (TAPP) technique in the treatment of inguinal and femoral hernias in emergency setting based on our experience, comparing indications and outcomes with the open technique.MethodsA retrospective analysis was performed including all patients with incarcerated and/or strangulated groin hernia who underwent emergency surgery from November 2019 to September 2022.Perioperative variables and short- and long-term outcomes were examined.Statistical analysis was performed using chi-square test for nominal variables and Student’s t test for continuous ones. A p value < 0.05 was considered statistically significant.ResultsSixty-six patients were included: 29 patients were treated with TAPP technique (Tapp group) and 37 with open technique plus diagnostic laparoscopy (Open group). Patients in the TAPP group were younger, had less severe clinical scenarios, and had a trend for lower Charlson Comorbidity Index, whereas ASA score and BMI were similar. The small bowel was more frequently herniated in the open group.Bilateral hernia repair was performed in 20.69% of patients in the Tapp group versus 0% in the Open group (p = 0.004). Bowel resection was more frequent in the open group (48.65% vs 0% of the Tapp group, p < 0.001) length of surgery was comparable in the two groups. In the Tapp group, the length of hospitalization was significantly shorter (2.59 ± 2.28 days vs. 9.08 ± 14.48 days; p = 0.023).Postoperative complications, according to Clavien-Dindo, were more severe in Open group where there were two deaths. There were no differences in the number of readmission and re-operations at 30 days and in the recurrence rate.ConclusionsEmergency repair of inguinal and femoral hernias using TAPP is a valuable option, safe and feasible in selected patients. In this series, indications for TAPP were reserved to younger patients with less comorbidities and less severe clinical scenario. Future randomized studies are needed to compare TAPP with open emergency hernia surgery in all settings. Potential advantages of TAPP are the reduction of postoperative complications, earlier recovery, and the possibility of bilateral treatment.

Femoral hernia in pediatric population: a diagnostic and surgical challenge.

Femoral hernia (FH) is a rare and often misdiagnosed pathology in pediatric population. The aim of our study was to describe the experience of a Tertiary Center in children with FH, underlying diagnostic and surgical details that could improve its management. A retrospective study of pediatric patients who underwent FH repair from January 2010 to June 2023 at our Institution was performed. In the analyzed period, 31 patients underwent surgical procedure for FH at our institution, of whom 16 (51.6%) were female. The mean age at time of surgery was 5.8years (range 0.5-17.1years). The rate of pre-operative misdiagnosis was 35.5% and open approach was adopted in all cases (16.1% with mesh application). Only two patients (6.4%) experienced surgical complications: one recurrence (repaired six months later) and one post-operative hematoma (treated successfully with conservative method). Due to the high rate of misdiagnosis, the variety of surgical approaches proposed, and the potential for intraoperative complications, FH poses a challenge for pediatric surgeons and urologists, as confirmed by the literature. It is essential to underline the importance of a proper clinical examination in order to correctly diagnose FH, make the best surgical plan for the patient and prevent post-operative complications.

No Reason to Use Mesh in Groin Hernia Repair in Adolescents.

Groin hernias are common and hernia repair is one of the most frequent surgical procedures performed worldwide. Despite this, there is no international guideline on the management of groin hernias in adolescents. Mesh reinforcement is used for repair in adults but not in young children. Adolescents, positioned between these age groups, pose unique challenges for surgeons due to their varying growth patterns. Placing a synthetic mesh in growing patients is a concern, particularly in relation to chronic pain. Traditionally, the hernia literature has defined adults as individuals aged 18years and above. Considering that growth can continue until age 19, this review proposes a revised definition of adolescence for patients with groin hernias encompassing ages 10 to 19. Symptomatic groin hernias in adolescents should be repaired with an open non-mesh technique because of acceptable recurrence rates and the desire to avoid introducing synthetic foreign materials into young patients with ongoing growth potential. Watchful waiting is suggested for asymptomatic groin hernias, postponing repair until the adolescent has become a fully grown adult and symptoms from the hernia develop. Most groin hernias in adolescents are lateral hernias, but before pursuing a watchful waiting strategy in females, an ultrasound or magnetic resonance imaging scan is suggested to rule out the presence of a femoral hernia that may need repair.

Strangulated femoral Littre hernia in a 72-year-old female: A case report

Abstract Littre’s hernia is an uncommon hernia, in which a Meckel’s diverticula protrudes through a potential opening in the abdominal wall. Littre’s hernia is seen in less than 1% of patients with a Meckel’s diverticulum, and the most common sites of the hernia include inguinal, umbilical, and femoral. In this report, we present a case of a femoral Littre hernia in a 72-year-old female repaired with femoral herniorrhaphy and laparoscopic-assisted small bowel resection.

Direct Inguinal Hernia in Pediatrics: Two case reports

Pediatric inguinal hernia occurs due to failure of closure of processus vaginalis. Aim of the procedure of indirect type in pediatrics is complete ligation of the sac. Direct and femoral hernias are extremely rare in pediatrics which could be easily detected from inside the abdomen especially during laparoscopic management. We present two rare cases of direct inguinal hernia

A Case of Laparoscopic Repair of Left Sciatic Hernia with Coexisting Femoral and Obturator Hernias

A Case of Laparoscopic Repair of Left Sciatic Hernia with Coexisting Femoral and Obturator Hernias

Femoral Hernia—A New Surgical Technique for Open Repair

Femoral Hernia—A New Surgical Technique for Open Repair

Emergency aid: emergency homeopathic treatment in a cat victim of a runway

The most common cause of shock in cats is trauma, due to fights with other animals and being run over. Regardless of the cause, shock can be fatal. Arnica montana is well used on tissues, skin and holes, always of traumatic origin. It reabsorbs internal bleeding, in addition to being a great option for controlling pain in these origins. This work aims to describe the use of homeopathy as a veterinary emergency tool, proving its effectiveness in supporting a cat victim of trauma due to being run over. A heavy seven-year-old mixed-breed cat received homeopathic support shortly after the trauma. Arnica montana 30 cH was administered in the plus method for two hours. Ultradilution kept the cat with a good breathing pattern and with all stimuli preserved, after six hours the patient presented cardiorespiratory arrest, leading to death. At necropsy, there was the presence of a discrete hematoma in the right lateral abdominal muscles and the presence of intestinal loops in the right internal femoral bone, characterizing a femoral hernia. The choice was unique and its use corroborates the well-being measures and responsibility of the Veterinarian in providing the first care. This study allowed a greater elucidation of the applicability of homeopathic therapy in the veterinary emergency room.

Frequency of Abdominal Wall Hernias: A Nigerian Hospital Experience

Introduction: Hernia is a very common condition in all populations, and its surgical operation constitutes a major workload for physicians worldwide. Although great numbers of these procedures are done in primary and secondary care settings as well as in private hospitals and as part of surgical missions to rural areas, a significant proportion is still present in tertiary centers. Aim: To review the pattern of external hernias operated upon in Federal Medical Centre, Owerri, over a 10-year period. Methods: The theatre records were searched for all patients who underwent surgical operations for hernia in the period of 2005–2014. The data on patient demographics, indication for surgery, and procedure performed were retrieved. Results: A total of 902 patients underwent operations for different types of external hernias. The overall male/female ratio was 2.6:1. Operations for inguinal hernia were the most common, accounting for 72.9% (658) of the total. Ventral hernias constituted 25.1% (n=227) of the cases whereas 1.5% (n = 12) of patients had femoral hernia. One hundred and twelve patients (12.4%) had emergency surgery, of which 78 were for inguinal hernia. Mesh repair was started in 2009 and was utilized in 72 (8%) cases. Laparoscopic method of repair was used in only two patients. Conclusion: The pattern of operation for hernia in our center mirrors the experience in other local centers. Modern methods of repair are gaining ground.

Acil inguinal hernilerde cerrahi yaklaşıma etki eden faktörler: Tek merkez deneyimi

Objective&#x0D; The aim is to establish the principles of surgery for patients who have undergone emergency groin hernia surgery by examining risk factors, diagnostic modalities, time to operation, and surgical techniques.&#x0D; Methods&#x0D; A retrospective analysis was conducted on patients who underwent groin hernia repair surgery between the years 2017 and 2022. The study evaluated various parameters such as demographic characteristics, physical examination findings, co-morbidities, radiologic assessments, operation notes, time of arrival to the hospital, and the duration of the operation. Data was collected from the hospital's electronic medical records system. Based on the mode of pre-operative assessment, patients were classified into two groups: group 1, comprising patients whose decision for surgery was based on physical examination alone, and group 2, comprising patients who underwent radiologic assessment prior to the operation.&#x0D; Result&#x0D; The risk evaluation of patients who underwent emergent hernia surgery revealed a higher incidence of women gender (25%) and femoral hernia type (16.6%) as compared to the elective surgery group, where the incidence was 6.7% and 1.6%, respectively. The diagnosis of patients was primarily based on physical examination findings, although radiologic methods were used preoperatively in 75% of the cases. It was observed that radiologic assessments increased the duration of the operation and resulted in higher morbidity and intestinal resection rates.&#x0D; Conclusion&#x0D; Radiologic methods, apart from in cases of suspected conditions such as obesity and recurrent hernias, may lead to delayed treatment and increased morbidity and mortality rates in patients undergoing emergent hernia surgery. Prompt surgical intervention based on physical examination findings is crucial in cases of strangulation or incarceration. In instances of spontaneous reduction, incisional exploration, hernioscopy, laparoscopy, or laparotomy should be considered if there is any suspicion of intestinal viability.

A CLINICAL PROFILE AND RISK FACTORS IN VENTRAL HERNIA PATIENTS: A RETROSPECTIVE STUDY

Introduction: About 4% of all hernia patients admitted to the ward had ventral hernias. Obesity, wound infections, malnutrition, immunosuppression, and inappropriate suture materials or incorrect suture placement were important causative factors for ventral hernia. Methods: This retrospective study was carried out among 50 patients of ventral hernias. Data were compiled in a pre-designed proforma using information from clinical notes, discharge summaries, and operation notes. This study excluded patients under the age of 18, those with femoral, inguinal, or posterior abdominal wall hernias. Results: The most common subtype of ventral hernia was incisional hernia (54.0%). The most common presenting symptom was swelling only (60.0%). The most common associated risk factor was obesity (36.0%) and constipation (26.0%). About 48.0% hernia occurred following gynecological procedures (hysterectomy - 22.0%, lower segment cesarean section - 8.0%, and tubectomy - 8.0%). Conclusion: The most common ventral hernia is the incisional hernia, which often occurs after obstetric and gynecological surgeries. Surgical site infection, obesity, and constipation increase the risk of ventral hernias.