Revisiting femoral hernia diagnosis rates by patient sex in inguinal hernia repairs.

Guidelines recommend MIS repairs for females with inguinal hernias, despite limited evidence. We investigated rates of femoral hernias intraoperatively noted during MIS and Lichtenstein repairs in females. ACHQC was queried for adult females undergoing inguinal hernia repair between January 2014-November 2022. Outcomes included identified femoral hernia and size, hernia recurrence, quality of life, and sex-based recurrence. 1357 and 316 females underwent MIS and Lichtenstein inguinal repair respectively. Femoral hernias were identified more frequently in MIS than open repairs (27%vs12%; (p ​< ​0.001). Most femoral hernias in MIS (61%) and Lichtenstein repairs (62%) were <1.5 ​cm(p ​< ​0.001). Identification rates of femoral hernias >3 ​cm were 1% overall(p ​= ​0.09). Surgeon and patient-reported recurrences were similar between approaches at 1-5-years for females(p ​> ​0.05 for all) and similar between sexes(p ​> ​0.05). Most incidental femoral hernias are small and both repair approaches demonstrated similar outcomes. The recommendation for MIS inguinal hernia repairs in females is potentially overstated.

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Declaration of competing interest All authors have read and approved the manuscript. This manuscript is not under consideration elsewhere. This research was not funded.