Department of Surgery, HCA Healthcare Kingwood, University of Houston, Kingwood, TX, USA.
Department of Surgery, University of Miami Miller School of Medicine, 1800 NW 10th Ave, Miami, FL, 33136, USA.
Hernia. 2023 Dec;27(6):1467-1472. doi: 10.1007/s10029-023-02754-7. Epub 2023 Feb 16.
Occult hernias, hernias seen on radiologic imaging but not felt on physical exam, are common. Despite their high prevalence, little is known about the natural history of this finding. Our aim was to determine and report on the natural history of patients with occult hernias including the impact on abdominal wall quality of life (AW-QOL), need for surgery, and risk of acute incarceration/strangulation.
This was a prospective cohort study of patients who underwent a computed tomography (CT) abdomen/pelvis scan from 2016 to 2018. Primary outcome was change in AW-QOL using the modified Activities Assessment Scale (mAAS), a hernia-specific, validated survey (1 = poor, 100 = perfect). Secondary outcomes included elective and emergent hernia repairs.
A total of 131 (65.8%) patients with occult hernias completed follow-up with a median (IQR) of 15.4 (22.5) months. Nearly half of these patients (42.8%) experienced a decrease in their AW-QOL, 26.0% were unchanged, and 31.3% reported improvement. One-fourth of patients (27.5%) underwent abdominal surgery during the study period: 9.9% were abdominal procedures without hernia repair, 16.0% involved elective hernia repairs, and 1.5% were emergent hernia repairs. AW-QOL improved for patients who underwent hernia repair (+ 11.2 ± 39.7, p = 0.043) while those who did not undergo hernia repair experienced no change in AW-QOL (- 3.0 ± 35.1).
When untreated, patients with occult hernias on average experience no change in their AW-QOL. However, many patients experience improvement in AW-QOL after hernia repair. Additionally, occult hernias have a small but real risk of incarceration requiring emergent repair. Further research is needed to develop tailored treatment strategies.
隐匿疝是指在影像学检查中可见但在体格检查中不可触及的疝，较为常见。尽管隐匿疝的发病率很高，但人们对其自然病史知之甚少。我们的目的是确定和报告隐匿疝患者的自然病史，包括对腹壁生活质量（AW-QOL）的影响、手术需求以及急性嵌顿/绞窄的风险。
这是一项对 2016 年至 2018 年间接受腹部/骨盆 CT 扫描的患者进行的前瞻性队列研究。主要结局是使用改良活动评估量表（mAAS）评估 AW-QOL 的变化，mAAS 是一种疝特异性的、经过验证的调查（1=差，100=优）。次要结局包括择期和急诊疝修补术。
共有 131 名（65.8%）隐匿疝患者完成了随访，中位（IQR）随访时间为 15.4（22.5）个月。这些患者中有近一半（42.8%）AW-QOL 下降，26.0%无变化，31.3%报告改善。四分之一的患者（27.5%）在研究期间接受了腹部手术：9.9%为无疝修补的腹部手术，16.0%为择期疝修补术，1.5%为急诊疝修补术。接受疝修补术的患者 AW-QOL 改善（+11.2±39.7，p=0.043），而未接受疝修补术的患者 AW-QOL 无变化（-3.0±35.1）。
未治疗的隐匿疝患者平均 AW-QOL 无变化。然而，许多患者在疝修补术后 AW-QOL 得到改善。此外，隐匿疝有发生需要急诊修复的嵌顿的小但真实风险。需要进一步研究来制定针对隐匿疝的治疗策略。
