Elsevier

Surgery

Volume 141, Issue 2, February 2007, Pages 262-266
Surgery

Original communication
Risk factors for inguinal hernia in adult males: A case-control study

https://doi.org/10.1016/j.surg.2006.04.014Get rights and content

Background

Inguinal hernia is one of the most common surgical pathologies. Research studies on clinical factors predisposing a person for the development of inguinal hernia, however, remain scarce. 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.

Methods

Between January 2002 and January 2004, a total of 1,418 male patients were recruited at the general surgical or hernia clinic of a University-affiliated teaching hospital. Patients were divided into case and control groups according to the presence of a primary inguinal hernia. Each patient was interviewed by a research assistant using a standardized questionnaire. Clinical data were studied by multivariate, logistic regression analyses to identify independent predictors of inguinal hernia in adult males.

Results

Clinical factors associated with the presence of inguinal hernia included a higher work activity index (P = 0.03), a higher total activity index (P = 0.01), a positive family history of inguinal hernia (P < 0.01, odds ratio = 8.73), and chronic obstructive airway disease (P = 0.04, odds ratio = 2.04). After adjustments for the type of hernia, chronic obstructive airway disease was a risk factor only for direct hernia, whereas total activity index and family history of hernia remained significantly related to both direct and indirect hernias. On logistic regression analyses, positive family history of hernia was the only independent predictor for inguinal hernia.

Conclusions

Family history of hernia was the most important determinant factor for developing inguinal hernia in adult males. A male subject who has a positive family history of hernia is 8 times more likely to develop a primary inguinal hernia.

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.

Section snippets

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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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.

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