Skip to main content

Advertisement

SpringerLink
Log in

Limited Potential for Prevention of Emergency Surgery for Femoral Hernia

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Femoral hernias are frequently operated on as an emergency. Emergency procedures for femoral hernia are associated with an almost tenfold increase in postoperative mortality, while no increase is seen for elective procedures, compared with a background population.

Objective

The aim of this study was to compare whether symptoms from femoral hernias and healthcare contacts prior to surgery differ between patients who have elective and patients who have emergency surgery.

Methods

A total of 1,967 individuals operated on for a femoral hernia over 1997–2006 were sent a questionnaire on symptoms experienced and contact with the healthcare system prior to surgery for their hernia. Answers were matched with data from the Swedish Hernia Register.

Results

A total of 1,441 (73.3 %) patients responded. Awareness of their hernia prior to surgery was denied by 53.3 % (231/433) of those who underwent an emergency procedure. Of the emergency operated patients, 31.3 % (135/432) negated symptoms in the affected groin prior to surgery and 22.2 % (96/432) had neither groin nor other symptoms. Elective patients had a considerably higher contact frequency with their general practitioner, as well as the surgical outpatient department, prior to surgery compared with patients undergoing emergency surgery (p < 0.001).

Conclusions

Patients who have elective and patients who have emergency femoral hernia surgery differ in previous symptoms and healthcare contacts. Patients who need emergency surgery are often unaware of their hernia and frequently completely asymptomatic prior to incarceration. Early diagnosis and expedient surgery is warranted, but the lack of symptoms hinders earlier detection and intervention in most cases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Glassow F (1985) Femoral hernia: review of 2,105 repairs in a 17 year period. Am J Surg 150:353–356

    Article  CAS  PubMed  Google Scholar 

  2. Bay-Nielsen M, Kehlet H, Strand L et al (2001) Quality assessment of 26,304 herniorrhaphies in Denmark: a prospective nationwide study. Lancet 358:1124–1128

    Article  CAS  PubMed  Google Scholar 

  3. Dahlstrand U, Wollert S, Nordin P et al (2009) Emergency femoral hernia repair: a study based on a national register. Ann Surg 249:672–676

    Article  PubMed  Google Scholar 

  4. Kulah B, Kulacoglu IH, Oruc MT et al (2001) Presentation and outcome of incarcerated external hernias in adults. Am J Surg 181:101–104

    Article  CAS  PubMed  Google Scholar 

  5. Kurt N, Oncel M, Ozkan Z et al (2003) Risk and outcome of bowel resection in patients with incarcerated groin hernias: retrospective study. World J Surg 27:741–743. doi:10.1007/s00268-003-6826-x

    Article  PubMed  Google Scholar 

  6. Alvarez JA, Baldonedo RF, Bear IG et al (2004) Incarcerated groin hernias in adults: presentation and outcome. Hernia 8:121–126

    Article  CAS  PubMed  Google Scholar 

  7. Ge BJ, Huang Q, Liu LM et al (2010) Risk factors for bowel resection and outcome in patients with incarcerated groin hernias. Hernia 14:259–264

    Article  PubMed  Google Scholar 

  8. van den Heuvel B, Dwars BJ, Klassen DR et al (2011) Is surgical repair of an asymptomatic groin hernia appropriate? A review. Hernia 15:251–259

    Article  PubMed  Google Scholar 

  9. Gunnarsson U, Degerman M, Davidsson A et al (1999) Is elective hernia repair worthwhile in old patients? Eur J Surg 165:326–332

    Article  CAS  PubMed  Google Scholar 

  10. Nilsson H, Stylianidis G, Haapamaki M et al (2007) Mortality after groin hernia surgery. Ann Surg 245:656–660

    Article  PubMed Central  PubMed  Google Scholar 

  11. Dahlstrand U, Sandblom G, Nordin P et al (2011) Chronic pain after femoral hernia repair: a cross-sectional study. Ann Surg 254:1017–1021

    Article  PubMed  Google Scholar 

  12. McEntee GP, O’Carroll A, Mooney B et al (1989) Timing of strangulation in adult hernias. Br J Surg 76:725–726

    Article  CAS  PubMed  Google Scholar 

  13. Roth N, Gangl O, Havlicek W et al (2010) The impact of emergency surgery on results of femoral hernia repair. Eur Surg 42:299–303

    Article  Google Scholar 

  14. Alani A, Page B, O’Dwyer PJ (2006) Prospective study on the presentation and outcome of patients with an acute hernia. Hernia 10:62–65

    Article  CAS  PubMed  Google Scholar 

  15. Tiernan JP, Katsarelis H, Garner JP et al (2010) Excellent outcomes after emergency groin hernia repair. Hernia 14:485–488

    Article  CAS  PubMed  Google Scholar 

  16. Malek S, Torella F, Edwards PR (2004) Emergency repair of groin herniae: outcome and implications for elective surgery waiting times. Int J Clin Pract 58:207–209

    Article  CAS  PubMed  Google Scholar 

  17. Nilsson E, Haapaniemi S, Gruber G et al (1998) Methods of repair and risk for reoperation in Swedish hernia surgery from 1992 to 1996. Br J Surg 85:1686–1691

    Article  CAS  PubMed  Google Scholar 

  18. Ludvigsson JF, Otterblad-Olausson P, Pettersson BU et al (2009) The Swedish personal identity number: possibilities and pitfalls in healthcare and medical research. Eur J Epidemiol 24:659–667

    Article  PubMed Central  PubMed  Google Scholar 

  19. von Elm E, Altman DG, Egger M et al (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370:1453–1457

    Article  Google Scholar 

  20. Rai S, Chandra SS, Smile SR (1998) A study of the risk of strangulation and obstruction in groin hernias. Aust N Z J Surg 68:650–654

    Article  CAS  PubMed  Google Scholar 

  21. Humes DJ, Radcliffe RS, Camm C et al (2013) Population-based study of presentation and adverse outcomes after femoral hernia surgery. Br J Surg 100:1827–1832

    Article  CAS  PubMed  Google Scholar 

  22. Suppiah A, Gatt M, Barandiaran J et al (2007) Outcomes of emergency and elective femoral hernia surgery in four district general hospitals: a 4-year study. Hernia 11:509–512

    Article  CAS  PubMed  Google Scholar 

  23. Abi-Haidar Y, Sanchez V, Itani K (2011) Risk factors and outcomes of acute versus elective groin hernia surgery. J Am Coll Surg 213:363–369

    Article  PubMed  Google Scholar 

  24. Gallegos NC, Dawson J, Jarvis M et al (1991) Risk of strangulation in groin hernias. Br J Surg 78:1171–1173

    Article  CAS  PubMed  Google Scholar 

  25. Simons MP, Aufenacker T, Bay-Nielsen M et al (2009) European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 13:343–403

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Rosemar A, Angerås U, Rosengren A et al (2010) Effect of body mass index on groin hernia surgery. Ann Surg 252:397–401

    Article  PubMed  Google Scholar 

  27. Nilsson H, Nilsson E, Angeras U et al (2011) Mortality after groin hernia surgery: delay of treatment and cause of death. Hernia 15(3):301–307

    Article  CAS  PubMed  Google Scholar 

  28. Kjaergaard J, Bay-Nielsen M, Kehlet H (2010) Mortality following emergency groin hernia surgery in Denmark. Hernia 14:351–355

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The work was funded by grants from Uppsala-Örebro Regional Research Council and Stockholm County Council.

Conflict of interest

The authors declare no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Surgical Science, Uppsala University, Uppsala, Sweden

    Ursula Dahlstrand & Staffan Wollert

  2. CLINTEC, Karolinska Institutet, Stockholm, Sweden

    Ursula Dahlstrand, Gabriel Sandblom & Ulf Gunnarsson

  3. Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden

    Ursula Dahlstrand, Gabriel Sandblom & Ulf Gunnarsson

Authors
  1. Ursula Dahlstrand
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gabriel Sandblom
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Staffan Wollert
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ulf Gunnarsson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ursula Dahlstrand.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PDF 162 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dahlstrand, U., Sandblom, G., Wollert, S. et al. Limited Potential for Prevention of Emergency Surgery for Femoral Hernia. World J Surg 38, 1931–1936 (2014). https://doi.org/10.1007/s00268-014-2539-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-014-2539-6

Keywords

Search

Navigation