Yansheng Zheng, Yuling Xue, Keling Li, Zhe Zhang, Zhenhui Wan, Haipeng Huang, Wenjun Xiong, Jin Li
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引用次数: 0
Abstract
Background: Occult inguinal hernia is a unique clinical challenge characterized by asymptomatic presentation and the absence of detectable signs on physical examination, leading to frequent misdiagnosis and underdiagnosis. The advancement of laparoscopic hernia surgery has facilitated the identification of occult hernias, yet effective diagnostic and predictive methods remain lacking.
Objective: This study aims to evaluate the incidence and clinical characteristics of occult inguinal hernias detected during laparoscopic unilateral inguinal hernia repair and to provide evidence-based recommendations for their management.
Methods: A retrospective analysis was conducted on 868 patients diagnosed preoperatively with unilateral inguinal hernia at the Guangdong Provincial Hospital of Traditional Chinese Medicine between January 2013 and December 2020. All patients underwent laparoscopic hernia repair surgery, during which both sides of the inguinal area were explored for occult hernias. Statistical analysis, including univariate and multivariate logistic regression, was performed to identify significant predictors of occult hernias.
Results: Intraoperative detection of occult inguinal hernias was observed in 225 patients (25.92%). Patients with occult inguinal hernia had a higher median age of 68 (59, 76) years, compared to 63 (52, 73) years for those with unilateral inguinal hernia. The incidence was notably higher in females (34.61%) compared to males (25.37%). Stratified by hernia type, the prevalence of occult hernias was 23.84% among patients with indirect hernias (154/646) and 31.75% among those with direct hernias (60/189). Among the 225 patients with occult hernias, 129(57.33%) occult hernias cases occurred on the left side, and 142(63.11%) occult hernias cases were of the indirect type. Multivariate logistic regression analysis identified female gender, high age, and the presence of high-risk factors for intra-abdominal hypertension as independent and significant predictors of occult hernia development.
Conclusion: Occult inguinal hernia remains a diagnostic and therapeutic challenge. For older patients presenting with unilateral inguinal hernia and high-risk factors for intra-abdominal hypertension, we recommend TAPP exploration and simultaneous repair of contralateral occult hernias.
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.
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