Division of Urology, Department of Surgery, E-Da Cancer and E-Da Hospital, Kaohsiung, Taiwan.
School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
Surg Endosc. 2024 Nov;38(11):6605-6613. doi: 10.1007/s00464-024-11233-8. Epub 2024 Sep 16.
Limited reports have discussed the risk factors for contralateral inguinal hernia (CIH) repair. We generated a risk factor scoring system to predict CIH within 3 years after unilateral inguinal hernia repair.
We extracted the admission data of patients aged ≥ 18 years who underwent primary unilateral inguinal hernia repair without any other operation from the National Health Insurance Research Database. Patients were randomly divided into 80% and 20% validation cohorts. Multivariate analysis with a logistic regression model was used to generate the scoring system, which was used in the validation group.
Overall, 170,492 adult men were included, with a median follow-up of 87 months. The scoring system ranged from 0-5 points, composited with age (< 45 years, 0 points; 45-65 years, 2 points; 65-80 years, 3 points; > 80 years, 2 points) and two comorbidities (cirrhosis and prostate disease: 1 point each). The areas under receiver operating characteristic (ROC) curves were 0.606 and 0.551 for the derivation and validation groups, respectively. The rates and adjusted odds ratios (OR) of CIH repair in the derivation group were 3.0% at 0-2 points, 5.5% (1.854, p < 0.001) at 3, 6.7% (2.279, p < 0.001) at 4, and 6.9% (2.348, p < 0.001) at 5, with similar results in the validation group [2.3% at 0-2 points, 3.8% (1.668, p < 0.001) at 3, 5.4% (2.386, p < 0.001) at 4, and 6.8% (3.033, p < 0.001) at 5].
The CIH scoring system effectively predicted CIH repair within three years of primary unilateral inguinal hernia repair. Surgeons could perform laparoscopic surgery with CIH scores > 2 points which enables easier contralateral exploration and repair during the same surgery, without additional incisions, to minimize the need for future surgeries. However, further prospective validation of this scoring system is required.
目前已有少量研究探讨了对侧腹股沟疝（CIH）修补术的风险因素。我们建立了一个风险因素评分系统，用于预测单侧腹股沟疝修补术后 3 年内发生 CIH 的风险。
我们从全民健康保险研究数据库中提取了年龄≥18 岁、行单侧腹股沟疝无其他手术修补术的患者的入院数据。患者被随机分为 80%和 20%验证队列。使用 logistic 回归模型进行多变量分析，生成评分系统，并在验证组中进行验证。
共有 170492 名成年男性入组，中位随访时间为 87 个月。评分系统的范围为 0-5 分，综合考虑年龄（<45 岁，0 分；45-65 岁，2 分；65-80 岁，3 分；>80 岁，2 分）和两种合并症（肝硬化和前列腺疾病：各 1 分）。推导组和验证组的受试者工作特征（ROC）曲线下面积分别为 0.606 和 0.551。推导组的 CIH 修补术发生率和校正比值比（OR）分别为：0-2 分，3.0%（1.854，p<0.001）；3 分，5.5%（1.854，p<0.001）；4 分，6.7%（2.279，p<0.001）；5 分，6.9%（2.348，p<0.001），验证组也得到了类似的结果[0-2 分，2.3%；3 分，3.8%（1.668，p<0.001）；4 分，5.4%（2.386，p<0.001）；5 分，6.8%（3.033，p<0.001）]。
CIH 评分系统能有效预测单侧腹股沟疝修补术后 3 年内的 CIH 修补术。对于 CIH 评分>2 分的患者，外科医生可以行腹腔镜手术，在同一手术中更容易进行对侧探查和修补，无需额外切口，从而减少未来手术的需要。但需要进一步前瞻性验证该评分系统。
