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Effect of Body Mass Index on Groin Hernia Surgery

Rosemar, Anders MD*; Angerås, Ulf MD, PhD*; Rosengren, Annika MD, PhD; Nordin, Pär MD, PhD‡§

doi: 10.1097/SLA.0b013e3181e985a1
Original Article

Objective: To analyze the effect of underweight, overweight, and obesity in relation to clinical characteristics, the risk of postoperative complications, 30-day mortality, and reoperations for recurrence after groin hernia surgery.

Summary of Background Data: Groin hernia surgery is one of the most frequent operations performed in general surgery. Several studies have demonstrated a protective effect of overweight and obesity on the risk of developing primary groin hernia. However, obesity has also been suggested to increase the risk for recurrence of groin hernia.

Methods: Through the Swedish Hernia Register, 49,094 primary groin hernia operations were identified between January 1, 2003 and December 31, 2007. Patients were divided into 4 body mass index (BMI) groups: BMI 1, <20 kg/m2; BMI 2, 20 to 25 kg/m2; BMI 3, 25–30 kg/m2; and BMI 4, >30 kg/m2.

Results: Of the 49,094 patients, 3.5% had a BMI <20 kg/m2 and 5.2% were obese. Altogether, women constituted only 7.7% of the studied group, but among patients with BMI <20 kg/m2 that had surgical procedures for femoral hernia, 81.4% were women. The relation between BMI and postoperative complications was U-shaped and after adjustment for age, gender, and emergency procedure, patients with BMI <20 and >25 had a significant increased risk when compared with patients with BMI from 20 to 25. Reoperation for recurrence of groin hernia has an increased hazard ratio of 1.20 (95% confidence interval, 1.00–1.40) in overweight, which was particularly evident after open suture and preperitoneal mesh techniques.

Conclusions: In this large and unselected population of patients with a first surgical procedure for groin hernia a relative dominance of female and femoral hernias presented as an emergency condition was observed in the low BMI group. The prevalence of obesity was markedly low. Both lean and obese patients had an increased risk for postoperative complications.

We conducted a large national register study focusing on body mass index in 49,094 primary groin hernia repairs, their basic characteristics related to different body mass indices, and its effect on outcome in the form of postoperative complications, reoperations for recurrence, and mortality.

From the Departments of *Surgery and †Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden; ‡Department of Surgery, Östersund Hospital, Östersund, Sweden; and §Department of Surgical and Perioperative Sciences, Umeå University, Sweden.

Supported by Gothenburg Medical Society and by the County Council of Jämtland. The Swedish Hernia Register is financially supported by the National Board of Health and Welfare and by the surgical units participating in SHR and are described in:

Reprints: Anders Rosemar, MD, Department of Surgery, Sahlgrenska University Hospital/Östra, SE-416 85 Göteborg, Sweden. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.