Emergency femoral hernia repair: a study based on a national register.
OBJECTIVE
To describe the characteristics of femoral hernias and outcome of femoral repairs, with special emphasis on emergency operations.


BACKGROUND
Femoral hernias account for 2% to 4% of all groin hernias. However, the lack of large-scale studies has made it impossible to draw conclusions regarding the best management of these hernias.


METHODS
The study is based on patients 15 years or older who underwent groin hernia repair 1992 to 2006 at units participating in the Swedish Hernia Register.


RESULTS
Three thousand nine hundred eighty femoral hernia repairs were registered, 1490 on men and 2490 on women: 1430 (35.9%) patients underwent emergency surgery compared with 4.9% of the 138,309 patients with inguinal hernias. Bowel resection was performed in 22.7% (325) of emergent femoral repairs and 5.4% (363) of emergent inguinal repairs. Women had a substantial over risk for undergoing emergency femoral surgery compared with men (40.6% vs. 28.1%). An emergency femoral hernia operation was associated with a 10-fold increased mortality risk, whereas the risk for an elective repair did not exceed that of the general population. In elective femoral hernias, laparoscopic (hazard ratio, 0.31; 95% confidence interval, 0.15-0.67) and open preperitoneal mesh (hazard ratio, 0.28; confidence interval, 0.12-0.65) techniques resulted in fewer re-operations than suture repairs.


CONCLUSIONS
Femoral hernias are more common in women and lead to a substantial over risk for an emergency operation, and consequently, a higher rate of bowel resection and mortality. Femoral hernias should be operated with high priority to avoid incarceration and be repaired with a mesh.
Dahlstrand
Ursula
U
Department of Surgery, Uppsala University, Uppsala University Hospital, 75185 Uppsala, Sweden. ursula.dahlstrand@surgsci.uu.se
Wollert
Staffan
S
Nordin
Pär
P
Sandblom
Gabriel
G
Gunnarsson
Ulf
U
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D016001:Confidence Intervals; D004638:Emergency Treatment; D005260:Female; D005500:Follow-Up Studies; D006550:Hernia, Femoral / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011336:Probability; D016016:Proportional Hazards Models; D012008:Recurrence; D012042:Registries; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D013526:Surgical Mesh; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult