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The etiology of indirect inguinal hernias: congenital and/or acquired?

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Abstract

The development of indirect inguinal hernias in infants is caused by a patent processus vaginalis (PPV). Consequently, this type of hernia is cured by simple herniotomy. In adults, however, herniotomy alone is accompanied by a high recurrence rate. This indicates that additional factors play a part in the development of indirect inguinal hernias in adults. The aim of this study was to determine the etiology of the development of an indirect hernia in adult life. Also, the prevalence of a PPV without clinical evidence of a hernia was determined and related to age. From November 1998 until February 2002, 599 patients from four different teaching hospitals, who underwent abdominal laparoscopy for various pathologies, were included. During laparoscopy, the deep inguinal ring was bilaterally inspected. Patients undergoing laparoscopy for inguinal hernia repair were excluded. Mean age was 45 years (range 8–89 years). Thirty-two percent (189/599) were male. Twelve percent (71/599) had PPV, all without clinical symptoms. Fifty-five percent (39/71) with PPV were male (P<0.0001). Fifty-nine percent (42/71) with PPV were right-sided, 29% (21/71) with PPV were left sided, and 12% (8/71) were bilateral (P=0.01). The prevalence of PPV in patients under 20 years was 22%. Of those between 20 and 30 years of age, 6% had PPV. Of those between 30 and 50 years, 24 patients (11%) had PPV. Of patients over 50 years, 33 (14%) had PPV. No significant differences between ages were observed. It is concluded that asymptomatic patent processus vaginalis frequently exists in adult life. The prevalence of PPV does not increase significantly with age. Assuming that indirect hernias start with asymptomatic peritoneal protrusion that can be observed laparoscopically, the incidence of PPV, like the incidence of adult indirect hernias, should increase in case of acquired etiology. Such an increase of incidence with age was not confirmed by our results. It is concluded that the etiology of indirect inguinal hernia in adults, as in infants, is congenital.

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References

  1. Brendan Devlin H, Kingsnorth A, O'Dwyer PJ, Bloor K (1998) General Introduction and History of Hernia Surgery. In: Management of Abdominal Hernias, 2nd edn. Chapman & Hall Medical, London, Chap 1

  2. Brendan Devlin H, Kingsnorth A, O'Dwyer PJ, Bloor K (1998) Epidemiology and Aetiology of Primary Groin Hernias in Adults. In: Management of Abdominal Hernias, 2nd edn. : Chapman & Hall Medical, London, Chap 3

  3. Abrahamson J (1998) Etiology and Pathophysiology of Primary and Recurrent Groin Hernia Formation. Surg Clin N Am 78(6):953–972

    Article  CAS  PubMed  Google Scholar 

  4. Thumbe VK, Evans DS (2001) To Repair or not to Repair Incidental Defects Found on Laparoscopic Repair of Groin Hernias. Surg Endosc 15:47–49

    Article  CAS  PubMed  Google Scholar 

  5. Mitchell GAG (1939) The Condition of the Peritoneal Processus at Birth. J Anat 73:658–661

    PubMed Central  CAS  PubMed  Google Scholar 

  6. Clarnette TD, Hutson JM (1999) The development and closure of the processus vaginalis. Hernia 3:97–102

    Article  Google Scholar 

  7. Brendan Devlin H, Kingsnorth A, O'Dwyer PJ, Bloor K (1998) Essential Anatomy of the Abdominal Wall. In: Management of Abdominal Hernias, 2nd edn. : Chapman & Hall Medical, London, Chap 2

  8. Spangen L (1995) Shutter Mechanisms in the Inguinal Canal. In: Arregui ME, Nagan RF (eds) Inguinal Hernia: Advances or Controversies. Radcliffe Med Press, Oxford, pp 55–59

    Google Scholar 

  9. Klinge U, Zheng H, Si ZY, Bhardwaj R, Klosterhalfen B, Schumpelick V (1999) Altered collagen synthesis in fascia transversalis of patients with inguinal hernia. Hernia 3:181–187

    Article  Google Scholar 

  10. Read RC (1998) The metabolic role in the attenuation of transversalis fascia found in patients with groin herniation. Hernia 2 (Suppl 1):17

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of General Surgery, Medical Center Rijnmond-Zuid, Location Clara, Olympiaweg 350, 3078 HT, Rotterdam, The Netherlands

    K. J. P. van Wessem & J. F. Lange

  2. Department of General Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands

    M. P. Simons

  3. Department of General Surgery, Albert Schweitzer Ziekenhuis, Dordrecht, The Netherlands

    P. W. Plaisier

Authors
  1. K. J. P. van Wessem
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  2. M. P. Simons
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  3. P. W. Plaisier
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  4. J. F. Lange
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Correspondence to K. J. P. van Wessem.

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van Wessem, K.J.P., Simons, M.P., Plaisier, P.W. et al. The etiology of indirect inguinal hernias: congenital and/or acquired?. Hernia 7, 76–79 (2003). https://doi.org/10.1007/s10029-002-0108-7

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  • DOI: https://doi.org/10.1007/s10029-002-0108-7

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