Original communicationRisk factors for inguinal hernia in adult males: A case-control study
Introduction
Hernia is a common surgical condition in males with a reported annual incidence of 13 per 10,000 population.1 The estimated lifetime risk of inguinal hernia in men is about 27%, which is 9-fold the risk for women.1 Postulated etiologies of primary inguinal hernia include the presence of a patent processus vaginalis, failure of the shutter mechanism, increased intra-abdominal pressure, and altered metabolism of collagen connective tissue and the extracellular matrix.2 These pathologic processes can be triggered by various patient-related factors, such as older age, gender, smoking, family history, and comorbidities.
Publications on risk factors for the development of inguinal hernia in adults remain scarce3, 4; besides, most postulated factors have been based on observations rather than statistical comparison with a control group. To our knowledge, 3 case-control studies have thus far evaluated the risk factors of inguinal hernia, but their sample sizes were small.5, 6, 7 Strenuous physical effort was found to be a significant risk factor for inguinal hernia in 2 studies,5, 6 but this finding was not substantiated by a recent report that focused only on women.7 The objective of the present study was to evaluate the risk factors for the development of inguinal hernia in adult males, using a case-control design in a hospital-based population. Identification of patient-related factors for the development of inguinal hernia may contribute to future health promotion and preventive care.
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Study population and setting
Between January 2002 and January 2004, male patients who presented with primary inguinal hernia at our general surgical or hernia specialist clinic, University of Hong Kong Medical Center, were recruited as cases. Our cluster hospitals, Tung Wah Hospital and Queen Mary Hospital, serve a population of about 0.6 million. The clinical diagnosis of primary inguinal hernia was based on the presence of a reducible inguinal swelling with an expansile cough impulse. Exclusion criteria included
Results
During the study period, interviews were completed for 1,778 subjects. Of these, 92 patients who presented with groin hernia and 268 control subjects were excluded subsequently for various reasons. A total of 1,418 eligible male subjects, 709 cases with primary inguinal hernia, and 709 age-matched controls were recruited for analyses. All individuals were interviewed by a single research assistant. Table 1 compares the sociodemographic characteristics of the case and control groups. Males with
Discussion
Our results suggest that a positive family history of hernia is the most important determinant factor for inguinal hernia in adult males. Previous genetic studies also have demonstrated strong familial predisposition for inguinal hernia.7, 10, 11 Gong et al12 conducted a genetic analysis of 280 families with congenital indirect inguinal hernia. A frequent vertical transmission and high segregation pointed to an autosomal dominant inheritance with incomplete penetrance and preferential paternal
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Cited by (0)
Supported by CRCG grant, Faculty of Medicine, The University of Hong Kong, Hong Kong.
The abstract was awarded the 2nd prize of Best Resident Paper Contest at 15th Asian Congress of Surgery, Pattaya, Thailand. July 20-23, 2005.