A Systematic Review of the Association Between Obesity and Inguinal Hernias

Kourosh Sarkhosh, MD MSc FRCSC, Richdeep S Gill, MD, Daniel W Birch, MD MSc FRCSC, Xinzhe Shi, MPH, Shahzeer Karmali, BSc MD FRCSC. University of Alberta

Background: The prevalence of obesity continues to increase and is associated with increased abdominal girth and pressure. Inguinal hernia incidence has previously been associated with increased intra-abdominal pressures. Inguinal hernia repair is also a common operation performed in North America. The objective of this study is to systematically review the incidence of inguinal hernia and outcomes following inguinal hernia repair in the obese patients.

Methods: A comprehensive electronic data search of MEDLINE, PubMed, Embase, Scopus, Dare, Clinical Evidence, TRIP, Health Technology Database, Conference abstracts, clinical trials, and the Cochrane Library was completed. All English studies, with no date restrictions were included. All studies assessing either incidence of inguinal hernia in obese patients or inguinal hernia repair outcomes in obese patients were included. The primary outcome of interest was incidence of inguinal hernia in obese patients.

Results: After an initial screen of 3672 titles, 161 abstracts were reviewed, and 18 studies met the inclusion criteria. Following full-manuscript review, 8 studies were excluded. A total of 10 studies were included with a total of 70,730 patients. This included 4 case-control studies, 2 prospective registry reviews, 2 surveys, and 1 case series and 1 retrospective registry review. The incidence of hernia was lower in obese patients (BMI >30), compared to non-obese patients (8.3% vs. 15.6%, respectively). Complication rates ranged from 3.9 to 10.3% in the obese patients, compared to 2.7 to 7.1% in the non-obese patients. Average length of hospital stay was 4.8 days in the obese, compared to 2.8 days in the non-obese group. While there was a higher incidence of femoral hernias in thin (BMI < 20) patients, the incidence of direct, indirect and femoral hernias was identical between obese and non-obese patients. The recurrence rate seems to be similar between the obese and non-obese patients (1.5 and 1.2%, respectively).

Conclusion: Overall, incidence of inguinal hernias seems to be lower in obese patients. There seems to be a trend towards higher risk of complications and hospital stay in the obese patients following inguinal hernia repair, with no significant difference in the types of hernia, and in recurrence rates. Further research is needed to clarify the association between obesity and inguinal hernia occurrence.
 

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