Top

Published in:

16-02-2023 | Computed Tomography | Original Article

Natural history of occult hernias in adults at a safety-net hospital

Authors: D. Quach, N. B. Lyons, K. Nguyen, O. A. Olavarria, K. Bernardi, N. Neela, N. H. Dhanani, A. Jackson, Z. Ali, M. K. Liang

Published in: Hernia | Issue 6/2023

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusion

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.

Available only for authorised users

Miller J, Cho J, Michael MJ, Saouaf R, Towfigh S (2014) Role of imaging in the diagnosis of occult hernias. JAMA Surg 149(10):1077–1080. https://doi.org/10.1001/jamasurg.2014.484CrossRefPubMed

Christie MC, Manger JP, Khiyami AM, Ornan AA, Wheeler KM, Schenkman NS (2016) Occult radiographically evident port-site hernia after robot-assisted urologic surgery: incidence and risk factors. J Endourol 30(1):92–96. https://doi.org/10.1089/end.2015.0431CrossRefPubMed

Naguib N, Rafique H, Dhruva Rao PK, Longworth T, Soukias JM, Masoud A (2015) A review of the incidence of iatrogenic hernia in both laparoscopic and open colorectal surgery: using CT as the gold standard of detection, cohort study. Int J Surg 19:87–90. https://doi.org/10.1016/j.ijsu.2015.05.026CrossRefPubMed

Olavarria OA, Bernardi K, Holihan JL, Lyons NB, Shah P, Ko TC, Kao LS, Liang MK (2020) Prevalence and impact on quality of life of occult hernias among patients undergoing computed tomography. J Surg Res 253:121–126. https://doi.org/10.1016/j.jss.2020.03.039CrossRefPubMed

Cherla DV, Viso CP, Moses ML, Holihan JL, Ko TC, Kao LS, Andrassy RJ, Liang MK (2018) Clinical assessment, radiographic imaging, and patient self-report for abdominal wall hernias. J Surg Res 227:28–34. https://doi.org/10.1016/j.jss.2017.11.014CrossRefPubMed

Liang, MK. Patient centered outcomes among patients with and without ventral hernia. Clinicaltrials.gov. https://clinicaltrials.gov/ct2/show/NCT04355819?term=NCT04355819&draw=2&rank=1. Accessed 4 October 2022.

Enhancing the quality and transparency of health research. https://www.equator-network.org/reporting-guidelines/strobe/ Accessed 4 October 2022.

Krpata DM, Schmotzer BJ, Flocke S, Jin J, Blatnik JA, Ermlich B, Novitsky YW, Rosen MJ (2012) Design and initial implementation of HerQLes: a hernia-related quality-of-life survey to assess abdominal wall function. J Am Coll Surg 215(5):635–642. https://doi.org/10.1016/j.jamcollsurg.2012.06.412CrossRefPubMed

Poulose BK, Roll S, Murphy JW, Matthews BD, Todd Heniford B, Voeller G, Hope WW, Goldblatt MI, Adrales GL, Rosen MJ (2016) Design and implementation of the Americas hernia society quality collaborative (AHSQC): improving value in hernia care. Hernia 20(2):177–189. https://doi.org/10.1007/s10029-016-1477-7CrossRefPubMed

10.

McCarthy M Jr, Jonasson O, Chang CH, Pickard AS, Giobbie-Hurder A, Gibbs J, Edelman P, Fitzgibbons R, Neumayer L (2005) Assessment of patient functional status after surgery. J Am Coll Surg 201(2):171–178. https://doi.org/10.1016/j.jamcollsurg.2005.03.035CrossRefPubMed

11.

Neela N, Olavarria OA, Rondon AP, Bernardi K, Shah P, Dhanani N, Lyons N, Matta EJ, Hasapes JP, Liang MK (2022) Validation of the minimal clinically important difference for modified activities assessment scale. Am J Surg 223(4):770–773. https://doi.org/10.1016/j.amjsurg.2021.07.042.doi:10.1016/j.amjsurg.2021.07.042CrossRefPubMed

12.

Savulescu J, Wartolowska K, Carr A (2016) Randomised placebo-controlled trials of surgery: ethical analysis and guidelines. J Med Ethics 42(12):776–783. https://doi.org/10.1136/medethics-2015-103333CrossRefPubMed

13.

Baucom RB, Beck WC, Holzman MD, Sharp KW, Nealon WH, Poulose BK (2014) The importance of surgeon-reviewed computed tomography for incisional hernia detection: a prospective study. Am Surg 80(7):720–722CrossRefPubMed

14.

Miller J, Tregarthen A, Saouaf R, Towfigh S (2018) Radiologic reporting and interpretation of occult inguinal hernia. J Am Coll Surg 227(5):489–495. https://doi.org/10.1016/j.jamcollsurg.2018.08.003CrossRefPubMed

15.

Bedewi MA, El-Sharkawy MS, Al Boukai AA, Al-Nakshabandi N (2012) Prevalence of adult paraumbilical hernia. Assessment by high-resolution sonography: a hospital-based study. Hernia 16(1):59–62. https://doi.org/10.1007/s10029-011-0863-4CrossRefPubMed

16.

Deerenberg EB, Harlaar JJ, Steyerberg EW, Lont HE, van Doorn HC, Heisterkamp J, Wijnhoven BP, Schouten WR, Cense HA, Stockmann HB, Berends FJ, Dijkhuizen FPH, Dwarkasing RS, Jairam AP, van Ramshorst GH, Kleinrensink GJ, Jeekel J, Lange JF (2015) Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial. Lancet 386(10000):1254–1260. https://doi.org/10.1016/S0140-6736(15)60459-7CrossRefPubMed

17.

van den Heuvel B, Beudeker N, van den Broek J, Bogte A, Dwars BJ (2013) The incidence and natural course of occult inguinal hernias during TAPP repair: repair is beneficial. Surg Endosc 27(11):4142–4146. https://doi.org/10.1007/s00464-013-3008-2CrossRefPubMed

18.

Park JB, Chong DC, Reid JL, Edwards S, Maddern GJ (2022) Should asymptomatic contralateral inguinal hernia be laparoscopically repaired in the adult population as benefits greatly outweigh risks? A systematic review and meta-analysis. Hernia 26(4):999–1007. https://doi.org/10.1007/s10029-022-02611-zCrossRefPubMedPubMedCentral

19.

Dhanani NH, Olavarria OA, Wootton S, Petsalis M, Lyons NB, Ko TC, Kao LS, Liang MK (2021) Contralateral exploration and repair of occult inguinal hernias during laparoscopic inguinal hernia repair: systematic review and Markov decision process. BJS Open 5(2):zraa020. https://doi.org/10.1093/bjsopen/zraa020CrossRefPubMed

20.

Chiang CC, Yang HY, Hsu YC (2018) What happens after no contralateral exploration in total extraperitoneal (TEP) herniorrhaphy of clinical unilateral inguinal hernias? Hernia 22(3):533–540. https://doi.org/10.1007/s10029-018-1752-xCrossRefPubMed

Title: Natural history of occult hernias in adults at a safety-net hospital
Authors: D. Quach
N. B. Lyons
K. Nguyen
O. A. Olavarria
K. Bernardi
N. Neela
N. H. Dhanani
A. Jackson
Z. Ali
M. K. Liang
Publication date: 16-02-2023
Publisher: Springer Paris
Keywords: Computed Tomography
Abdominal Surgery
Computed Tomography
Published in: Hernia / Issue 6/2023
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI: https://doi.org/10.1007/s10029-023-02754-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Natural history of occult hernias in adults at a safety-net hospital

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2023

Nationwide analysis of open groin hernia repairs in Italy from 2015 to 2020

Investigating the safety and efficacy of nerve stimulation for management of groin pain after surgical herniorrhaphy: a systematic review and meta-analysis

The effects of dexamethasone added to ilioinguinal/iliohypogastric nerve (IIN/IHN) block on rebound pain in inguinal hernia surgery: a randomized controlled trial

Retraction Note: Retrospective study of preservation and transection of the round ligament of uterus during laparoscopic transabdominal preperitoneal inguinal hernia repair in adult women

Impact of laparoscopic repair on type III/IV giant paraesophageal hernias: a single-center experience

Transinguinal preperitoneal (TIPP) versus Lichtenstein for inguinal hernia repair: a systematic review and meta-analysis