Wong Harry J, Oh Cherin, Towfigh Shirin
Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Beverly Hills Hernia Center, 450 N Roxbury Drive, #224, Beverly Hills, CA, 90210, USA.
Surg Endosc. 2024 Dec;38(12):7525-7530. doi: 10.1007/s00464-024-11253-4. Epub 2024 Sep 16.
Hidden or occult inguinal hernias are symptomatic hernias that do not present with a bulge. For some surgeons, if a bulge is not present, then no hernia repair is contemplated. We report preoperative findings of patients with occult inguinal hernias and outcomes after repair to assist in early detection and treatment of this special population.
All patients who underwent inguinal hernia repairs, 2008-2019, were reviewed. Patients were classified as having occult inguinal hernias if they (a) complained of groin pain, (b) did not have bulging on exam, (c) had supportive imaging showing an inguinal hernia, and (d) were confirmed to have inguinal hernias that were repaired intraoperatively. Presentation and outcomes were compared with the non-occult group treated during the same time period.
Of 485 patients who underwent elective inguinal hernia repairs over 10 years, 212 (44%) had occult inguinal hernias. Patients in the occult group were significantly more likely to be female, younger, and with higher BMI compared to the non-occult group. They also had more preoperative pain for a significantly longer time. This was associated with higher incidence of pain medications usage, including opioids, in the occult group. On physical examination, those with occult hernias were twice as likely to have tenderness over the inguinal canal. Most hernia repairs (66%) were laparoscopic and 94% used mesh. Postoperatively, the occult group had 83% resolution of symptoms after hernia repair.
Some surgeons hesitate recommending hernia repair to patients with occult inguinal hernias, as these patients do not fit the traditional definition of a hernia, i.e., a bulge. Our study challenges this perception by showing that discounting groin pain due to occult hernia prolongs patient's suffering and may risk increased opioid use, especially in females, although 83% cure can be achieved with hernia repair.
隐匿性腹股沟疝是一种无肿块突出的有症状的疝。对于一些外科医生来说，如果没有肿块突出，就不会考虑进行疝修补术。我们报告隐匿性腹股沟疝患者的术前检查结果以及修补后的结局，以帮助早期发现和治疗这一特殊人群。
回顾了2008年至2019年期间所有接受腹股沟疝修补术的患者。如果患者（a）主诉腹股沟疼痛，（b）体格检查时无肿块突出，（c）影像学检查支持腹股沟疝的诊断，且（d）术中证实为腹股沟疝并进行了修补，则将其分类为隐匿性腹股沟疝。将这些患者的临床表现和结局与同期治疗的非隐匿性腹股沟疝组进行比较。
在10年期间接受择期腹股沟疝修补术的485例患者中，212例（44%）为隐匿性腹股沟疝。与非隐匿性腹股沟疝组相比，隐匿性腹股沟疝组患者女性更多、年龄更小且体重指数更高。他们术前疼痛的时间也更长且更为明显。这与隐匿性腹股沟疝组使用包括阿片类药物在内的止痛药物的发生率更高有关。体格检查时，隐匿性疝患者腹股沟管压痛的可能性是其他患者的两倍。大多数疝修补术（66%）采用腹腔镜手术，94%使用补片。术后，隐匿性腹股沟疝组83%的患者症状得到缓解。
一些外科医生对于向隐匿性腹股沟疝患者推荐疝修补术犹豫不决，因为这些患者不符合疝的传统定义，即有肿块突出。我们的研究表明，忽视隐匿性疝引起的腹股沟疼痛会延长患者的痛苦，并且可能增加阿片类药物的使用风险，尤其是在女性患者中，尽管疝修补术可以使83%的患者治愈，从而对这种观念提出了挑战。
