The missed diagnosis of femoral hernias in females undergoing inguinal hernia repair - A systematic review and proportional meta-analysis.

IF 2.6 2区医学 Q1 SURGERY Hernia Pub Date : 2024-11-16 DOI:10.1007/s10029-024-03196-5

Ana Caroline Dias Rasador, Carlos André Balthazar da Silveira, Gabriele Eckerdt Lech, Bruno Veronez de Lima, Diego Laurentino Lima, Flavio Malcher

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Abstract

Background: Given the 4-times higher prevalence of femoral hernias among females compared to males, this diagnosis may be missed during inguinal hernia repair (IHR), causing risk of reoperation for pseudo recurrence of femoral hernias (FH). Minimally invasive approaches are suggested as potential reducers of missed FH since they provide a posterior view of all defect areas, despite studies suggesting that women receive less MIS than men. We aim to assess the missed FH during IHR and after reoperation for recurrence following IHR in women.

Methods: PubMED, Cochrane, and EMBASE databases were searched for studies assessing patients undergoing recurrent IHR, analyzing the incidence of reoperation for FH and occult femoral hernias during IHR. Statistical analysis was performed using R software.

Results: From 6,226 records, 10 retrospective observational studies were included, totaling 15,863 patients (20% females). We found that 19.56 per 100 women (95% CI 8.34, 39.37) who are reoperated for an inguinal hernia are found as having a FH during the new repair. Compared to men, women were at a significantly higher risk to be reoperated for FH after IHR (RR 8.97; 95% CI 7.35, 10.93; P < 0.001). Our analysis also showed that 20.7% of females received MIS approaches for groin hernia repair, while 79.3% received open procedures. Furthermore, our study found a pooled incidence of occult FH during the initial IHR of 6.85 per 100 patients for both genders (95% CI 2.78, 15.90), which increased to 21.42 per 100 patients when assessing females only (95% CI 15.46, 28.89).

Conclusions: Females have a higher incidence of FH following reoperation for recurrence of inguinal hernia repair. Added to the high rate of occult FH encountered during inguinal procedures, this suggests a missed diagnosis of FH during IHR. The adoption of MIS IHR for women is fundamental to reduce the underdiagnosis of FH.

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接受腹股沟疝修补术的女性股疝的漏诊--系统综述和比例荟萃分析。

背景：女性股疝的发病率是男性的四倍，因此在腹股沟疝修补术（IHR）中可能会漏诊，导致股疝假性复发而再次手术的风险。尽管有研究表明女性接受微创手术的人数少于男性，但微创手术可提供所有缺损区域的后方视野，因此被认为是减少漏诊股疝的潜在方法。我们的目的是评估女性在 IHR 期间和 IHR 后复发的再次手术后漏诊的 FH：我们在 PubMED、Cochrane 和 EMBASE 数据库中搜索了评估复发性 IHR 患者的研究，分析了 IHR 期间 FH 和隐匿性股骨疝再次手术的发生率。统计分析使用 R 软件进行：从 6,226 份记录中纳入了 10 项回顾性观察研究，共计 15,863 名患者（女性占 20%）。我们发现，每 100 名接受腹股沟疝再次手术的女性中有 19.56 人（95% CI 8.34，39.37）在新的修复手术中被发现患有 FH。与男性相比，女性因腹股沟疝气再次手术的风险明显更高（RR 8.97; 95% CI 7.35, 10.93; P 结论：女性因腹股沟疝气再次手术的风险明显更高：女性因腹股沟疝修补术后复发而再次手术的 FH 发生率更高。加上腹股沟手术中隐匿性 FH 的高发率，这表明在 IHR 过程中存在漏诊 FH 的情况。对女性采用 MIS IHR 是减少 FH 漏诊的根本。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hernia SURGERY-

CiteScore

4.90

自引率

26.10%

发文量

171

审稿时长

4-8 weeks

期刊介绍： Hernia was founded in 1997 by Jean P. Chevrel with the purpose of promoting clinical studies and basic research as they apply to groin hernias and the abdominal wall . Since that time, a true revolution in the field of hernia studies has transformed the field from a ”simple” disease to one that is very specialized. While the majority of surgeries for primary inguinal and abdominal wall hernia are performed in hospitals worldwide, complex situations such as multi recurrences, complications, abdominal wall reconstructions and others are being studied and treated in specialist centers. As a result, major institutions and societies are creating specific parameters and criteria to better address the complexities of hernia surgery. Hernia is a journal written by surgeons who have made abdominal wall surgery their specific field of interest, but we will consider publishing content from any surgeon who wishes to improve the science of this field. The Journal aims to ensure that hernia surgery is safer and easier for surgeons as well as patients, and provides a forum to all surgeons in the exchange of new ideas, results, and important research that is the basis of professional activity.