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Prospective evaluation of 6895 groin hernia repairs in women
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
Surgical Directorate, Arrowe Park Hospital NHS Trust, Wirral, UK.
Vrinnevi Hospital, Norrköping.
Östersund Hospital, Östersund, Sweden.
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2005 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 92, no 12, 1553-1558 p.Article in journal (Refereed) Published
Abstract [en]

Background: Although 8 per cent of groin hernia repairs are performed in women, there is little published literature relating specifically to women. This study compared differences in outcome between women and men after groin hernia repair.

Methods: Data collected prospectively in the Swedish Hernia Register between 1992 and 2003 were analysed, including 6895 groin hernia repairs in women and 83 753 in men.

Results: A higher proportion of emergency operations was carried out in women (16.9 per cent) than men (5.0 per cent), leading to bowel resection in 16.6 and 5.6 per cent respectively. During reoperation femoral hernias were found in 41.6 per cent of the women who were diagnosed with a direct or indirect inguinal hernia at the primary operation. The corresponding proportion for men was 4.6 per cent. The hernia repair was not classified as a standard operation (e.g. Shouldice, Lichtenstein, Plug/Mesh, TAPP/TEP) in 38.2 per cent of women and 11.2 per cent of men. Women had a significantly higher risk of reoperation for recurrence than men, and techniques associated with the lowest risk for reoperation in men had the highest risk in women.

Conclusion: A greater proportion of women than men require emergency groin hernia repair, with consequently higher rates of bowel resection, complications and death. Surgical techniques developed for use in men may put women at unnecessary risk. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.

Place, publisher, year, edition, pages
2005. Vol. 92, no 12, 1553-1558 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-33238DOI: 10.1002/bjs.5156Local ID: 19237OAI: diva2:254061
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2012-09-10Bibliographically approved
In thesis
1. Audit of Groin Hernia Repair II
Open this publication in new window or tab >>Audit of Groin Hernia Repair II
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Groin hernia repair is one of the most common operations performed in general  surgery, and every fourth man is expected to have a hernia operation during his lifetime. Although 8% of all repairs are performed in women, there is little published literature relating specifically to female anatomy, risk factors and techniques. There is a continuing development of new mesh materials and health care reorganization with specialized surgical clinics changing the availability of basic surgery for surgeons under training.

In 1997 a thesis was published by Anders Kald, Audit of Groin Hernia Repair, which aimed to establish an audit of hernia surgery, evaluating management, risk factors, outcome and economy. The aim of this thesis was to continue the audit of hernia surgery in Sweden, allowing evaluation of gender issues, a new mesh material, and performance of surgeons under training.

Our data showed that women have a higher incidence of emergency groin hernia repair than men, and an increased rate of femoral recurrence after an inguinal hernia repair. Time to reoperation suggests that a primary misdiagnosis is common. Detection of femoral hernias could be increased by using preperitoneal techniques, visualizing all three groin hernia locations.

Patients who received a lightweight mesh at their hernia operation had a shorter convalescence, with faster return to work and normal activity.

It might be more efficient, but not necessarily better to let a specialized hernia surgeon perform the repair. Surgical trainees had more postoperative complications, but fewer patients had chronic pain at the long-term follow-up.

Abstract [sv]

Ljumskbråcksoperationen är en av de vanligaste operationerna inom allmänkirurgi och var fjärde man förväntas bli opererad för ett bråck under sin livstid. Trots att 8% av alla operationer utförs på kvinnor, finns det sparsamt med litteratur publicerat som rör kvinnlig anatomi, riskfaktorer och operationstekniker. Det utvecklas kontinuerligt nya nätmaterial och omorganisationer inom sjukvården med specialiserade kirurgiska kliniker har förändrat tillgängligheten på allmänkirurgi för kirurger under utbildning.

1997 publicerade Anders Kald sin avhandling, Audit of Groin Hernia Repair, vilken hade som syfte att etablera en kvalitetssäkring av bråckkirurgin, med utvärdering av handläggning, riskfaktorer, resultat och ekonomi. Syftet med denna avhandling var att fortsätta kvalitetssäkra bråckkirurgin i Sverige, med utvärdering av genusfrågor, ett nytt nätmaterial och prestationen hos kirurger under utbildning.

Våra data visade att kvinnor har högre incidens av akut bråckoperation än män, och ökad frekvens av femoralbråcksrecidiv efter en inguinalbråcksoperation. Tiden till reoperation tyder på en initial feldiagnos och preperitoneala tekniker rekommenderas för att öka identifieringen av femoralbråck.

Patienter som fått ett lättviktsnät vid sin bråckoperation hade en kortare konvalesens med snabbare återgång till arbete och normala aktiviteter.

Det kan vara effektivare, men inte nödvändigtvis bättre att låta en specialiserad bråckkirurg att utföra operationen. Kirurger under utbildning hade fler postoperativa komplikationer, men färre patienter med kronisk smärta vid långtidsuppföljningen.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2010. 45 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1221
National Category
Medical and Health Sciences
urn:nbn:se:liu:diva-63645 (URN)978-91-7393-262-2 (ISBN)
Public defence
2010-12-15, Katastrofmedicinskt centrum, Hälsouniversitetet, Campus US, Linköpings universitet, Linköping, 09:00 (Swedish)

On the day of the defence date the title of article III was: "Groin hernia repair with Titanium Coated Mesh compared to Prolene Mesh: A Prospective Randomized Controlled Trial".

Available from: 2010-12-29 Created: 2010-12-29 Last updated: 2015-06-05Bibliographically approved

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