Content area
Full Text
World J Surg (2013) 37:306311 DOI 10.1007/s00268-012-1842-3
ORIGINAL SCIENTIFIC REPORTS
Direct and Recurrent Inguinal Hernias are Associated with Ventral Hernia Repair: A Database Study
Nadia A. Henriksen Lars T. Sorensen
Morten Bay-Nielsen Lars N. Jorgensen
Published online: 28 November 2012 Socit Internationale de Chirurgie 2012
AbstractBackground A systemically altered connective tissue metabolism has been demonstrated in patients with abdominal wall hernias. The most pronounced connective tissue changes are found in patients with direct or recurrent inguinal hernias as opposed to patients with indirect inguinal hernias. The aim of the present study was to assess whether direct or recurrent inguinal hernias are associated with an elevated rate of ventral hernia surgery.
Methods In the nationwide Danish Hernia Database, a cohort of 92,457 patients operated on for inguinal hernias was recorded from January 1998 until June 2010. Eight-hundred forty-three (0.91 %) of these patients underwent a ventral hernia operation between January 2007 and June 2010. A multivariate logistic regression analysis was applied to assess an association between inguinal and ventral hernia repair.
Results Direct (Odds Ratio [OR] = 1.28 [95 % CI,1.081.51]) and recurrent (OR = 1.76, [95 % CI,1.392.23]) inguinal hernias were signicantly associated with ventral hernia repair after adjustment for age, gender, and surgical approach (open or laparoscopic).
Conclusions Patients with direct and recurrent inguinal herniation are more prone to ventral hernia repair than patients with indirect inguinal herniation. This is the rst study to show that herniogenesis is associated with type of inguinal hernia.
Introduction
Inguinal hernia has been considered an anatomical disease [1], where a prerequisite for an indirect inguinal hernia is a patent embryologic processus vaginalis, whereas a direct inguinal hernia requires a weakness in the posterior wall of the inguinal canal [2]. Lately it has been suggested that defective connective tissue metabolism is involved in the pathogenesis of both the indirect and the direct types of inguinal hernia [3]. The collagen metabolism of hernia patients is altered locally in the fascial tissue of the abdominal wall and systemically, as shown by skin biopsies [4, 5]. The tissue of hernia patients expresses higher levels of type III collagen relative to type I collagen [6]. These changes appear to be related to the type of hernia, as the imbalance between type III and...