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Emergency Femoral Hernia Repair: A Study Based on a National Register

Dahlstrand, Ursula MD*; Wollert, Staffan MD, PhD*; Nordin, Pär MD, PhD†; Sandblom, Gabriel MD, PhD‡; Gunnarsson, Ulf MD, PhD‡

doi: 10.1097/SLA.0b013e31819ed943
Original Articles

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.

Data from the Swedish Hernia Register demonstrates that emergency femoral hernia repair is associated with a high rate of bowel resection, complications, and mortality. Femoral hernias should, to avoid incarceration, be operated electively with high priority, in which case a preperitoneal mesh technique reduces the risk for recurrence related reoperation.

From the *Department of Surgery, Uppsala University, Uppsala, Sweden; †Department of Surgery, Östersund Hospital, Östersund, Sweden; and ‡Division of Surgery, CLINTEC, Karolinska University Hospital Huddinge and Karolinska Institute, Stockholm, Sweden.

Supported by the National Board of Health and Welfare and by the Swedish Association of Local Authorities (to The Swedish Hernia Register).

Surgical units participating in SHR are available at: http://www.svensktbrackregister.se/kliniker.html.

Correspondence: Ursula Dahlstrand, Department of Surgery, Uppsala University, Uppsala University Hospital, 751 85 Uppsala, Sweden. E-mail: ursula.dahlstrand@surgsci.uu.se.

© 2009 Lippincott Williams & Wilkins, Inc.