Abdominal Wall Hernias in the Elderly

Living reference work entry


Abdominal wall hernia repair is the most common surgical procedure in the United States. With the US elderly population expected to nearly double in size from 2012 to 2050 (Ortman et al., US Census 1964:1–28, 2014), physicians should expect to see an increasing number of elderly patients presenting for evaluation and treatment of abdominal wall hernias. The elderly population deserves special attention as this population often has more comorbidities and shorter life expectancy as compared to a younger population. Thus, it is important for clinicians to discuss goals of care and the risks of treatment options with their elderly patients. Although there is a general paucity of data on outcomes in the elderly hernia population, more data is becoming available for review. Laparoscopic herniorrhaphy appears to be a safe technique for many elderly patients. Watchful waiting has also arisen as a potential option for patients with asymptomatic or minimally symptomatic groin and ventral hernias. This chapter will focus on the preoperative evaluation, repair, and complications of inguinal and incisional/ventral hernias in the elderly. Other hernias will be discussed separately at the end of the chapter.


Elderly hernia Inguinal Ventral Incisional Herniorrhaphy 


  1. 1.
    Ortman JM, Velkoff VA, Hogan H (2014) An aging nation: the older population in the United States. US Census 1964:1–28Google Scholar
  2. 2.
    Rutkow IM (2003) Demographic and socioeconomic aspects of hernia repair in the United States in 2003. Surg Clin North Am 83:1045–1051. Scholar
  3. 3.
    Deysine M, Grimson R, Soroff HS (1987) Herniorrhaphy in the elderly. Benefits of a clinic for the treatment of external abdominal wall hernias. Am J Surg 153:387–391. Scholar
  4. 4.
    Primatesta P, Goldacre MJ (1996) Inguinal hernia repair: incidence of elective and emergency surgery, readmission and mortality. Int J Epidemiol 25:835–839. Scholar
  5. 5.
    Oresanya LB, Lyons WL, Finlayson E (2014) Preoperative assessment of the older patient. JAMA 311:2110. Scholar
  6. 6.
    Law N, Trapnell J (1992) Does a truss benefit a patient with inguinal hernia? BMJ 304:1092CrossRefGoogle Scholar
  7. 7.
    Albright EL, Davenport DL, Roth JS (2012) Preoperative functional health status impacts outcomes after ventral hernia repair. Am Surg 78:230–234PubMedGoogle Scholar
  8. 8.
    Kristensen MT, Foss NB, Ekdahl C, Kehlet H (2010) Prefracture functional level evaluated by the New Mobility Score predicts in-hospital outcome after hip fracture surgery. Acta Orthop 81:296–302. Scholar
  9. 9.
    Li C, Carli F, Lee L et al (2013) Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study. Surg Endosc 27:1072–1082. Scholar
  10. 10.
    Harari D, Hopper A, Dhesi J et al (2007) Proactive care of older people undergoing surgery (‘POPS’): designing, embedding, evaluating and funding a comprehensive geriatric assessment service for older elective surgical patients. Age Ageing 36:190–196. Scholar
  11. 11.
    Fitzgibbons RJ, Forse RA (2015) Groin hernias in adults. N Engl J Med 372:756–763. Scholar
  12. 12.
    Rutledge RH (1993) The Cooper ligament repair. Surg Clin North Am 73:471–485. Scholar
  13. 13.
    Fagan SP, Awad SS (2004) Abdominal wall anatomy: the key to a successful inguinal hernia repair. Am J Surg 188:3–8. Scholar
  14. 14.
    Zollinger R Jr (1993) Atlas of surgical operations. McGraw Hill, New YorkGoogle Scholar
  15. 15.
    Nehme AE (1983) Groin hernias in elderly patients. Management and prognosis. Am J Surg 146:257–260CrossRefGoogle Scholar
  16. 16.
    Ponka JL, Brush BE (1974) Experiences with the repair of groin hernia in 200 patients aged 70 or older. J Am Geriatr Soc 22:18–24CrossRefGoogle Scholar
  17. 17.
    Williams JS, Hale HW (1966) The advisability of inguinal herniorrhaphy in the elderly. Surg Gynecol Obstet 122:100–104PubMedGoogle Scholar
  18. 18.
    Argenta L (2004) Basic science for surgeons. Saunders, PhiladelphiaGoogle Scholar
  19. 19.
    Kulah B, Duzgun AP, Moran M et al (2001) Emergency hernia repairs in elderly patients. Am J Surg 182:455–459. Scholar
  20. 20.
    Fitzgibbons RJ, Ramanan B, Arya S et al (2013) Long-term results of a randomized controlled trial of a nonoperative strategy (watchful waiting) for men with minimally symptomatic inguinal hernias. Ann Surg 258:508–515. Scholar
  21. 21.
    Chung L, Norrie J, O’Dwyer PJ (2011) Long-term follow-up of patients with a painless inguinal hernia from a randomized clinical trial. Br J Surg 98:596–599. Scholar
  22. 22.
    Ryan E (1956) An analysis of 313 consecutive cases of indirect sliding inguinal hernias. Surg Gynecol Obstet 102:45–58PubMedGoogle Scholar
  23. 23.
    Szczesny W, Cerkaska K, Tretyn A, Dabrowiecki S (2006) Etiology of inguinal hernia: ultrastructure of rectus sheath revisited. Hernia 10:266–271. Scholar
  24. 24.
    Pans A, Albert A, Lapière CM, Nusgens B (2001) Biochemical study of collagen in adult groin hernias. J Surg Res 95:107–113. Scholar
  25. 25.
    Abrahamson J (1998) Etiology and pathophysiology of primary and recurrent groin hernia formation. Surg Clin North Am 78:953–972. , vi. Scholar
  26. 26.
    Greene WW (1969) Bowel obstruction in the aged patient. A review of 300 cases. Am J Surg 118:541–545CrossRefGoogle Scholar
  27. 27.
    Fenyö G (1974) Diagnostic problems of acute abdominal diseases in the aged. Acta Chir Scand 140:396–405PubMedGoogle Scholar
  28. 28.
    Hair A, Paterson C, Wright D et al (2001) What effect does the duration of an inguinal hernia have on patient symptoms? J Am Coll Surg 193:125–129CrossRefGoogle Scholar
  29. 29.
    Alimoglu O, Kaya B, Okan I et al (2006) Femoral hernia: a review of 83 cases. Hernia 10:70–73. Scholar
  30. 30.
    Chandler JJ (2005) Groin hernias and masses, and abdominal hernias. In: Lowry SF (ed) Learning surgery: the surgery clerkship manual. Springer Science+Business Media, New York, p 479–493Google Scholar
  31. 31.
    Lilly MC, Arregui ME (2002) Ultrasound of the inguinal floor for evaluation of hernias. Surg Endosc 16:659–662. Scholar
  32. 32.
    van den Berg JC, de Valois JC, Go PM, Rosenbusch G (1999) Detection of groin hernia with physical examination, ultrasound, and MRI compared with laparoscopic findings. Investig Radiol 34:739–743CrossRefGoogle Scholar
  33. 33.
    Miller J, Cho J, Michael MJ et al (2014) Role of imaging in the diagnosis of occult hernias. JAMA Surg 149:1077. Scholar
  34. 34.
    Pallati PK, Gupta PK, Bichala S et al (2013) Short-term outcomes of inguinal hernia repair in octogenarians and nonagenarians. Hernia 17:723–727. Scholar
  35. 35.
    Beadles CA, Meagher AD, Charles AG (2015) Trends in emergent hernia repair in the United States. JAMA Surg 150:194–200. Scholar
  36. 36.
    Huerta S, Pham T, Foster S et al (2014) Outcomes of emergent inguinal hernia repair in veteran octogenarians. Am Surg 80:479–483PubMedGoogle Scholar
  37. 37.
    Lewis DC, Moran CG, Vellacott KD (1989) Inguinal hernia repair in the elderly. J R Coll Surg Edinb 34:101–103PubMedGoogle Scholar
  38. 38.
    Wantz GE (1997) A 65-year-old man with an inguinal hernia. JAMA 277:663–669CrossRefGoogle Scholar
  39. 39.
    Abi-Haidar Y, Sanchez V, Itani KMF (2011) Risk factors and outcomes of acute versus elective groin hernia surgery. J Am Coll Surg 213:363–369. Scholar
  40. 40.
    Gallegos NC, Dawson J, Jarvis M, Hobsley M (1991) Risk of strangulation in groin hernias. Br J Surg 78:1171–1173CrossRefGoogle Scholar
  41. 41.
    Rebuffat C, Galli A, Scalambra MS, Balsamo F (2006) Laparoscopic repair of strangulated hernias. Surg Endosc 20:131–134. Scholar
  42. 42.
    Yerdel MA, Akin EB, Dolalan S et al (2001) Effect of single-dose prophylactic ampicillin and sulbactam on wound infection after tension-free inguinal hernia repair with polypropylene mesh: the randomized, double-blind, prospective trial. Ann Surg 233:26–33CrossRefGoogle Scholar
  43. 43.
    Wysocki A, Pozniczek M, Krzywon J, Bolt L (2001) Use of polypropylene prostheses for strangulated inguinal and incisional hernias. Hernia 5:105–106CrossRefGoogle Scholar
  44. 44.
    Rosenthal R (1998) Physiologic considerations in the elderly patient. In: Miller T (ed) Modern surgical care, 2nd edn. Quality Medical, St Louis, pp 1362–1384Google Scholar
  45. 45.
    Van Den Heuvel B, Dwars BJ, Klassen DR, Bonjer HJ (2011) Is surgical repair of an asymptomatic groin hernia appropriate? A review. Hernia 15:251–259. Scholar
  46. 46.
    Nilsson H, Nilsson E, Angerås U, Nordin P (2011) Mortality after groin hernia surgery: delay of treatment and cause of death. Hernia 15:301–307. Scholar
  47. 47.
    Bellows CF, Robinson C, Fitzgibbons RJ et al (2014) Watchful waiting for ventral hernias: a longitudinal study. Am Surg 80:245–252PubMedGoogle Scholar
  48. 48.
    Fitzgibbons RJ Jr, Giobbie-Hurder A, Gibbs JO et al (2006) Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial. J Am Med Assoc 295:285–292. Scholar
  49. 49.
    O’Dwyer PJ, Norrie J, Alani A et al (2006) Observation or operation for patients with an asymptomatic inguinal hernia: a randomized clinical trial. Ann Surg 244:167–173. Scholar
  50. 50.
    Thompson JS, Gibbs JO, Reda DJ et al (2008) Does delaying repair of an asymptomatic hernia have a penalty? Am J Surg 195:89–93. Scholar
  51. 51.
    Sarosi GA, Wei Y, Gibbs JO et al (2011) A clinician’s guide to patient selection for watchful waiting management of inguinal hernia. Ann Surg 253:605–610. Scholar
  52. 52.
    Nilsson H, Stylianidis G, Haapamäki M et al (2007) Mortality after groin hernia surgery. Ann Surg 245:656–660. Scholar
  53. 53.
    Wu JJ, Baldwin BC, Goldwater E, Counihan TC (2016) Should we perform elective inguinal hernia repair in the elderly? Hernia 1–7.
  54. 54.
    Guillen J, Aldrete JA (1970) Anesthetic factors influencing morbidity and mortality of elderly patients undergoing inguinal herniorrhaphy. Am J Surg 120:760–763CrossRefGoogle Scholar
  55. 55.
    Nordin P, Zetterström H, Gunnarsson U, Nilsson E (2003) Local, regional, or general anaesthesia in groin hernia repair: multicentre randomised trial. Lancet 362:853–858. Scholar
  56. 56.
    van Veen RN, Mahabier C, Dawson I et al (2008) Spinal or local anesthesia in Lichtenstein hernia repair. Ann Surg 247:428–433. Scholar
  57. 57.
    Özgün H, Kurt MN, Kurt I, Çevikel MH (2002) Comparison of local, spinal, and general anaesthesia for inguinal herniorrhaphy. Eur J Surg 168:455–459. Scholar
  58. 58.
    Amid PK, Shulman AG, Lichtenstein IL (1994) Local anesthesia for inguinal hernia repair step-by-step procedure. Ann Surg 220:735–737CrossRefGoogle Scholar
  59. 59.
    Chan CK, Chan G (2006) The Shouldice technique for the treatment of inguinal hernia. J Minim Access Surg 2:124–128. Scholar
  60. 60.
    McGavin L (1909) The double-filigree operation for the radical cure of inguinal hernia, with notes of thirty-three cases; and on certain cases of ventral hernia cured by the implantation of filigree. Br Med J 2:357–363CrossRefGoogle Scholar
  61. 61.
    Usher F, Cogan J, Lowry T (1960) A new technique for the repair of inguinal and incisional hernias. Arch Surg 81:847–854CrossRefGoogle Scholar
  62. 62.
    Usher FC (1970) The repair of incisional and inguinal hernias. Surg Gynecol Obstet 131:525–530PubMedGoogle Scholar
  63. 63.
    Usher FC, Hill JR, Ochsner JL (1959) Hernia repair with Marlex mesh. Surgery 46:718–724. Scholar
  64. 64.
    Lichtenstein IL, Shulman AG (1986) Ambulatory outpatient hernia surgery. Including a new concept, introducing tension-free repair. Int Surg 71:1–4PubMedGoogle Scholar
  65. 65.
    Nordin P, Bartelmess P, Jansson C et al (2002) Randomized trial of Lichtenstein versus Shouldice hernia repair in general surgical practice. Br J Surg 89:45–49. Scholar
  66. 66.
    EU Hernia Trialists Collaboration (2002) Repair of groin hernia with synthetic mesh: meta-analysis of randomized controlled trials. Ann Surg 235:322–332CrossRefGoogle Scholar
  67. 67.
    McCormack K, Scott N, Go P et al (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair (Review). Cochrane Database Syst Rev.
  68. 68.
    Deysine M, Grimson RC, Soroff HS (1991) Inguinal herniorrhaphy. Reduced morbidity by service standardization. Arch Surg 126:628–630CrossRefGoogle Scholar
  69. 69.
    Kingsnorth AN, Gray MR, Nott DM (1992) Prospective randomized trial comparing the Shouldice technique and plication darn for inguinal hernia. Br J Surg 79:1068–1070CrossRefGoogle Scholar
  70. 70.
    Panos RG, Beck DE, Maresh JE, Harford FJ (1992) Preliminary results of a prospective randomized study of Cooper’s ligament versus Shouldice herniorrhaphy technique. Surg Gynecol Obstet 175:315–319PubMedGoogle Scholar
  71. 71.
    Kux M, Fuchsjäger N, Schemper M (1994) Shouldice is superior to Bassini inguinal herniorrhaphy. Am J Surg 168:15–18CrossRefGoogle Scholar
  72. 72.
    Kingsnorth A, LeBlanc K (2003) Hernias: inguinal and incisional. Lancet 362:1561–1571. Scholar
  73. 73.
    Awad SS, Fagan SP (2004) Current approaches to inguinal hernia repair. Am J Surg 188:9–16. Scholar
  74. 74.
    Dieter RA (1999) Mesh plug migration into scrotum: a new complication of hernia repair. Int Surg 84:57–59PubMedGoogle Scholar
  75. 75.
    Kugel RD (2003) The Kugel repair for groin hernias. Surg Clin North Am 83:1119–1139. Scholar
  76. 76.
    Schroder DM, Lloyd LR, Boccaccio JE, Wesen CA (2004) Inguinal hernia recurrence following preperitoneal Kugel patch repair. Am Surg 70:132–136; discussion 136PubMedGoogle Scholar
  77. 77.
    Vironen J, Nieminen J, Eklund A, Paavolainen P (2006) Randomized clinical trial of Lichtenstein patch or Prolene Hernia System® for inguinal hernia repair. Br J Surg 93:33–39. Scholar
  78. 78.
    Huang CS, Huang CC, Lien HH (2005) Prolene hernia system compared with mesh plug technique: a prospective study of short- to mid-term outcomes in primary groin hernia repair. Hernia 9:167–171. Scholar
  79. 79.
    Feldman L, Wexler M, Fraser S (2005) Laparoscopic hernia repair. In: ACS surgery: principles and practices. WebMD, Inc, p 1–20Google Scholar
  80. 80.
    Fitzgibbons RJ, Salerno GM, Filipi CJ et al (1994) A laparoscopic intraperitoneal onlay mesh technique for the repair of an indirect inguinal hernia. Ann Surg 219:144–156CrossRefGoogle Scholar
  81. 81.
    McKernan JB, Laws HL (1993) Laparoscopic repair of inguinal hernias using a totally extraperitoneal prosthetic approach. Surg Endosc 7:26–28CrossRefGoogle Scholar
  82. 82.
    Ger R, Mishrick A, Hurwitz J et al (1993) Management of groin hernias by laparoscopy. World J Surg 17:46–50CrossRefGoogle Scholar
  83. 83.
    Ahmad G, Duffy JM, Phillips K, Watson A (2008) Laparoscopic entry techniques. In: Ahmad G (ed) Cochrane database of systematic reviews. Wiley, Chichester, p CD006583Google Scholar
  84. 84.
    Caglia P, Tracia A, Buffone A et al (2016) Physiopathology and clinical considerations of laparoscopic surgery in the elderly. Int J Surg 33:S97–S102. Scholar
  85. 85.
    McCormack K, Wake B, Perez J et al (2005) Laparoscopic surgery for inguinal hernia repair: systematic review of effectiveness and economic evaluation. Health Technol Assess 9:1–203, iii–ivCrossRefGoogle Scholar
  86. 86.
    Neumayer L, Giobbie-Hurder A, Jonasson O et al (2004) Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 350:1819–1827. Scholar
  87. 87.
    El-Dhuwaib Y, Corless D, Emmett C et al (2013) Laparoscopic versus open repair of inguinal hernia: a longitudinal cohort study. Surg Endosc 27:936–945. Scholar
  88. 88.
    Kevric J, Papa N, Toshniwal S et al (2017) Fifteen-year groin hernia trends in Australia: the era of minimally invasive surgeons. ANZ J Surg. [Epub ahead of print]
  89. 89.
    Kulacoǧlu HI, Ozmen MM, Oruç MT et al (2001) Laparoscopic herniorrhaphy: preference rate among surgeons in Ankara, Turkey. East Afr Med J 78:216–219CrossRefGoogle Scholar
  90. 90.
    Sanjay P, Woodward A (2007) A survey of inguinal hernia repair in Wales with special emphasis on laparoscopic repair. Hernia 11:403–407. Scholar
  91. 91.
    Zendejas B, Sc M, Ramirez T et al (2012) Trends in the utilization of inguinal hernia repair techniques: a population-based study. Am J Surg 203:313–317. Scholar
  92. 92.
    Velasco JM, Vallina VL, Esposito DJ, Theodore S (1998) Laparoscopic herniorrhaphy in the geriatric population. Am Surg 64:633–637PubMedGoogle Scholar
  93. 93.
    Hernandez-Rosa J, Lo CC, Choi JJ et al (2011) Laparoscopic versus open inguinal hernia repair in octogenarians. Hernia 15:655–658. Scholar
  94. 94.
    Hope WW, Bools L, Menon A et al (2013) Comparing laparoscopic and open inguinal hernia repair in octogenarians. Hernia 17:719–722. Scholar
  95. 95.
    Jeong O, Park Y-K (2011) Clinicopathological features and surgical treatment of gastric cancer in South Korea: the results of 2009 nationwide survey on surgically treated gastric cancer patients. J Gastric Cancer 11:69–77. Scholar
  96. 96.
    Brunt LM, Quasebarth MA, Dunnegan DL, Soper NJ (2001) Outcomes analysis of laparoscopic cholecystectomy in the extremely elderly. Surg Endosc 15:700–705. Scholar
  97. 97.
    Chen HH, Wexner SD, Weiss EG et al (1998) Laparoscopic colectomy for benign colorectal disease is associated with a significant reduction in disability as compared with laparotomy. Surg Endosc 12:1397–1400CrossRefGoogle Scholar
  98. 98.
    Koch A, Edwards A, Haapaniemi S et al (2005) Prospective evaluation of 6895 groin hernia repairs in women. Br J Surg 92:1553–1558. Scholar
  99. 99.
    Schouten N, Burgmans JPJ, van Dalen T et al (2012) Female “groin” hernia: totally extraperitoneal (TEP) endoscopic repair seems the most appropriate treatment modality. Hernia 16:387–392. Scholar
  100. 100.
    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. Scholar
  101. 101.
    Bay-Nielsen M, Kehlet H (2006) Inguinal herniorrhaphy in women. Hernia 10:30–33. Scholar
  102. 102.
    Rosenberg J, Bisgaard T, Kehlet H et al (2011) Danish Hernia Database recommendations for the management of inguinal and femoral hernia in adults. Dan Med Bull 58:C4243PubMedGoogle Scholar
  103. 103.
    Carter J, Duh Q-Y (2011) Laparoscopic repair of inguinal hernias. World J Surg 35:1519–1525. Scholar
  104. 104.
    Feliu X, Clavería R, Besora P et al (2011) Bilateral inguinal hernia repair: laparoscopic or open approach? Hernia 15:15–18. Scholar
  105. 105.
    Wauschkuhn CA, Schwarz J, Boekeler U, Bittner R (2010) Laparoscopic inguinal hernia repair: gold standard in bilateral hernia repair? Results of more than 2800 patients in comparison to literature. Surg Endosc 24:3026–3030. Scholar
  106. 106.
    Deans GT, Wilson MS, Royston CM, Brough WA (1995) Recurrent inguinal hernia after laparoscopic repair: possible cause and prevention. Br J Surg 82:539–541CrossRefGoogle Scholar
  107. 107.
    Wexler MJ (1997) The repair of inguinal hernia: 110 years after Bassini. Can J Surg 40:186–191PubMedPubMedCentralGoogle Scholar
  108. 108.
    Felix EL, Michas C (1993) Double-buttress laparoscopic herniorrhaphy. J Laparoendosc Surg 3:1–8CrossRefGoogle Scholar
  109. 109.
    Lowham AS, Filipi CJ, Fitzgibbons RJ et al (1997) Mechanisms of hernia recurrence after preperitoneal mesh repair. Traditional and laparoscopic. Ann Surg 225:422–431CrossRefGoogle Scholar
  110. 110.
    Junge K, Rosch R, Klinge U et al (2006) Risk factors related to recurrence in inguinal hernia repair: a retrospective analysis. Hernia 10:309–315. Scholar
  111. 111.
    Gilbert AI, Graham MF, Young J (2010) Management of recurrent inguinal hernias. J Am Coll Surg 210:371–372. Scholar
  112. 112.
    Franneby U, Sandblom G, Nordin P et al (2006) Risk factors for long-term pain after hernia surgery. Ann Surg 244:212–219. Scholar
  113. 113.
    Grant AM, Scott NW, Dwyer PJO et al (2004) Five-year follow-up of a randomized trial to assess pain and numbness after laparoscopic or open repair of groin hernia. Br J Surg 91:1570–1574. Scholar
  114. 114.
    Lik-Man Mui W, Ng CSH, Ming-Kit Fung T et al (2006) Prophylactic ilioinguinal neurectomy in open inguinal hernia repair. Ann Surg 244:27–33. Scholar
  115. 115.
    Amid PK, Hiatt JR (2007) New understanding of the causes and surgical treatment of postherniorrhaphy inguinodynia and orchalgia. J Am Coll Surg 205:381–385. Scholar
  116. 116.
    Heydorn WH, Velanovich V (1990) A five-year U.S. Army experience with 36,250 abdominal hernia repairs. Am Surg 56:596–600PubMedGoogle Scholar
  117. 117.
    Nieuwenhuizen J, Kleinrensink GJ, Hop WCJ et al (2008) Indications for incisional hernia repair: an international questionnaire among hernia surgeons. Hernia 12:223–225. Scholar
  118. 118.
    Nieuwenhuizen J, Halm JA, Jeekel J, Lange JF (2007) Natural course of incisional hernia and indications for repair. Scand J Surg 96:293–296. Scholar
  119. 119.
    Kaoutzanis C, Leichtle SW, Mouawad NJ et al (2015) Risk factors for postoperative wound infections and prolonged hospitalization after ventral/incisional hernia repair. Hernia 19:113–123. Scholar
  120. 120.
    Qin C, Hackett NJ, Kim JYS (2015) Assessing the safety of outpatient ventral hernia repair: a NSQIP analysis of 7666 patients. Hernia 19:919–926. Scholar
  121. 121.
    Spaniolas K, Trus TL, Adrales GL (2014) Ventral hernia repairs in the oldest-old: high-risk regardless of approach. Surg Endosc Other Interv Tech 28:1230–1237. Scholar
  122. 122.
    Heller L, McNichols CH, Ramirez OM (2012) Component separations. Semin Plast Surg 26:25–28. Scholar
  123. 123.
    Earle D, Scott Roth BJ, Alan Saber B et al (2016) SAGES guidelines for laparoscopic ventral hernia repair. Surg Endosc 30:3163–3183. Scholar
  124. 124.
    Goodney PP, Birkmeyer CM, Birkmeyer JD (2002) Short-term outcomes of laparoscopic and open ventral hernia repair: a meta-analysis. Arch Surg 137:1161–1165CrossRefGoogle Scholar
  125. 125.
    Forbes SS, Eskicioglu C, McLeod RS, Okrainec A (2009) Meta-analysis of randomized controlled trials comparing open and laparoscopic ventral and incisional hernia repair with mesh. Br J Surg 96:851–858. Scholar
  126. 126.
    Colavita PD, Tsirline VB, Belyansky I et al (2012) Prospective, long-term comparison of quality of life in laparoscopic versus open ventral hernia repair. Ann Surg 256:714–723. Scholar
  127. 127.
    Bingener J (2007) Long-term outcomes in laparoscopic vs open ventral hernia repair. Arch Surg 142:562. Scholar
  128. 128.
    Itani KMF, Hur K, Kim LT et al (2016) Comparison of laparoscopic and open repair with mesh for the treatment of ventral incisional hernia. Arch Surg 145:322–328. Scholar
  129. 129.
    Lee YK, Iqbal A, Vitamvas M et al (2008) Is it safe to perform laparoscopic ventral hernia repair with mesh in elderly patients? Hernia.
  130. 130.
    Mislowsky A, Hemphill A, Nasrallah DV (2008) A scarless technique of umbilical hernia repair in the adult population. Hernia.
  131. 131.
    Blumberg NA (1980) Infantile umbilical hernia. Surg Gynecol Obstet 150:187–192PubMedGoogle Scholar
  132. 132.
    Shankar DA, Itani KMF, O’Brien WJ, Sanchez VM (2017) Factors associated with long-term outcomes of umbilical hernia repair. JAMA Surg.
  133. 133.
    Kadirov S, Sayfan J, Friedman S, Orda R (1996) Richter’s hernia – a surgical pitfall. J Am Coll Surg 182:60–62PubMedGoogle Scholar
  134. 134.
    Skandalakis PN, Zoras O, Skandalakis JE, Mirilas P (2006) Richter hernia: surgical anatomy and technique of repair. Am Surg 72:180PubMedGoogle Scholar
  135. 135.
    Boughey JC, Nottingham JM, Walls AC (2003) Richter’s hernia in the laparoscopic era: four case reports and review of the literature. Surg Laparosc Endosc Percutan Tech 13:55–58CrossRefGoogle Scholar
  136. 136.
    Ziegler DW, Rhoads JE (1995) Obturator hernia needs a laparotomy, not a diagnosis. Am J Surg 170:67–68CrossRefGoogle Scholar
  137. 137.
    Chang S-S, Shan Y-S, Lin Y-J et al (2005) A review of obturator hernia and a proposed algorithm for its diagnosis and treatment. World J Surg 29:450–454; discussion 454. Scholar
  138. 138.
    Ijiri R, Kanamaru H, Yokoyama H et al (1996) Obturator hernia: the usefulness of computed tomography in diagnosis. Surgery 119:137–140CrossRefGoogle Scholar
  139. 139.
    Short AR (1923) Treatment of strangulated obturator hernia. Br Med J 1:718CrossRefGoogle Scholar
  140. 140.
    Fakim A, Walker MA, Byrne DJ, Forrester JC (1991) Recurrent strangulated obturator hernia. Ann Chir Gynaecol 80:317–320PubMedGoogle Scholar
  141. 141.
    Bergstein JM, Condon RE (1996) Obturator hernia: current diagnosis and treatment. Surgery 119:133–136CrossRefGoogle Scholar
  142. 142.
    Stoppa RE, Rives JL, Warlaumont CR et al (1984) The use of Dacron in the repair of hernias of the groin. Surg Clin North Am 64:269–285CrossRefGoogle Scholar
  143. 143.
    Moreno-Egea A, Carrasco L, Girela E et al (2002) Open vs laparoscopic repair of spigelian hernia: a prospective randomized trial. Arch Surg 137:1266–1268CrossRefGoogle Scholar
  144. 144.
    Bhatia TP, Ghimire P, Panhani ML (2010) Spigelian hernia. Kathmandu Univ Med J (KUMJ) 8:241–243Google Scholar
  145. 145.
    Webber V, Low C, Skipworth RJE et al (2017) Contemporary thoughts on the management of Spigelian hernia. Hernia.

Authors and Affiliations

  1. 1.Division of Plastic and Reconstructive SurgeryDuke UniversityDurhamUSA

Section editors and affiliations

  • Jason Johanning
    • 1
  • Sandhya Lagoo-Deenadayalan
    • 2
  1. 1.Department of SurgeryUniversity of Nebraska Medical CenterOmahaUSA
  2. 2.Duke MedicineDurhamUSA

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