Natural history of groin hernias in women and factors leading to delay in repair: a single-institution study.

Abstract

<h4>Background</h4>The objective of this study was to describe the natural history of groin hernias in women at a high-volume tertiary medical center. Specifically, we abstracted the duration of symptoms prior to diagnosis, imaging modalities used, and operative findings. We hypothesized that females would experience a protracted preoperative clinical course.<h4>Methods</h4>Our institutional hernia database was queried for elective groin hernia repairs from January 2018 to July 2023. Analyses were used to measure and describe demographics, clinical characteristics, and operative findings. In addition, patients' zip codes were linked to census track area deprivation index (ADI) values and a semi-qualitative inquiry was performed to explore reasons for the protracted preoperative clinical course.<h4>Results</h4>Among 1331 patients, 8.4% were female. Majority were Caucasian (68.8%) and overweight (BMI 27.3 ± 5.8), averaging 61.2 years of age. Majority reported non-specific groin pain (73.8%) and an intermittent groin bulge (48.8%), with 40% experiencing symptoms for > 1 year. Patients averaged 1.2 clinic visits before seeing a surgeon. Indirect inguinal hernias were the most common (81.3%), followed by femoral (35%) and direct (26.3%). Sixty-three patients had preoperative imaging, including CT (56.8%), US (39.2%), and MRI (4.0%). The most common surgical approach was robotic (68.8%) followed by laparoscopic-TEP (22.5%). When stratified by duration of symptoms, ADI did not differ among our cohort (p = 0.497). Patient-related reasons for delaying surgery included interpersonal stressors (3.1%), symptoms not limiting ADLs (34.4%), and fear of mesh complications (3.1%). Providers advised against surgery due to malnutrition (3.1%), multiple prior repairs (9.4%), concomitant infection (3.1%), and severe ascites (6.3%).<h4>Conclusion</h4>Our study provides some insight into reasons for delay in inguinal hernia repair for women. While many reported symptoms for over a year, a minority sought treatment until they were ready to proceed with surgery. Future qualitative studies are needed to more thoroughly assess female's perspectives with groin hernias.