Short summary

The aim of this study is to evaluate the risk of complications including hernia incarceration, bowel obstruction, and unremitting pain necessitating either hospital admission or acute surgery in conservatively managed symptomatic ventral and inguinal hernias in Danish patients. We identified all patients diagnosed with a first-time diagnosis of inguinal, ventral or femoral hernia at the Department of Abdominal Surgery, OUH, either at the surgical emergency department or in the outpatient clinic

Rationale

With a lifetime incidence of 27% in men and 3% in women, inguinal hernias are the most common type of hernia. Other types of hernias include ventral hernias such as umbilical, incisional, parastomal, and Spiegelian hernias. A hernia does not improve on its own and may become larger over time without treatment. However, most hernias are likely to cause little or no discomfort to the patient. In Denmark, around 13,000 patients undergo surgery for inguinal or ventral hernias annually. At the Danish public hospitals, it is not custom to operate asymptomatic patients. Instead, elective surgery is usually performed only in cases of femoral hernia, significant cosmetic complaints, and on patients with consistent discomfort despite conservative treatment e.g., with hernia belt support. In addition, women with either inguinal or femoral hernia undergo elective surgery, as it is clinically difficult to differentiate between the two types of hernia. Patients outside of these categories tend to be monitored by watchful waiting. However, leaving a hernia untreated may also increase the risk of complications such as bowel obstruction and strangulation of omentum or intestine, which may result in emergency surgery. The literature is inconsistent regarding risk of incarceration and emergency surgery. Risk of incarceration varies from 0.3% in inguinal hernias and up to 20% in femoral hernias resulting in emergency surgery. Other studies found that emergency surgery was performed in 1.5-15% in all patients with hernias due to unbearable pain or incarceration. The differences in risk estimates are likely due to differences in patient and hernia characteristics and in the thresholds of conservative versus surgical management. The reduction in elective surgery and out-patient clinic capacities following the Covid-19 outbreak have provided an opportunity to observe the spontaneous or natural history of various benign conditions such as hernias. This in turn allows us to estimate an absolute risk of complications to inguinal and ventral hernias. Thereby, clinicians and patients can make an informed and joint decision regarding conservative versus surgical management. The aim of this study is to evaluate the risk of complications in symptomatic inguinal and ventral hernias in Danish patients.

Description of the cohort

Inclusion of patients with a first-time diagnosis of inguinal, ventral or femoral hernia at the Department of Abdominal Surgery, OUH, either at the surgical emergency department or in the outpatient clinic, in the time period January 1, 2020 - December 31, 2023. Patients were excluded if they were asymptomatic, previously had undergone hernia surgery, or previously had a contact with a hernia diagnosis in order to reach a common baseline for all patients. Patients were followed-up until December 31, 2023.

Data and biological material

Diagnosis code, age, gender, BMI, ASA score, smoking, respiratory disease (chronic obstructive pulmonary disease, asthma), hernia size, comorbidity (connective tissue disorder, diabetes, malnutrition, chronic steroid use), time since debut of symptoms, and modality used to diagnose the hernia (clinical examination, CT, MRI, ultrasound).

Collaborating researchers and departments

Department of Surgery, Odense University Hospital, Odense, Denmark

• Anders Mark Christensen, MD, PhD
• Kristine Cederstrøm Larsen, MD

Department of Surgery, Esbjerg and Grindsted Hospital, Denmark

• Tine Lorentzen, MD