Comprehensive Retrospective Analysis of Inguinal Hernias and Our Experiences with Special Hernias

Abstract

Aim: This study aims to review specific types of inguinal hernias over the past three years and analyze the surgical decision-making processes based on recent literature. Materials and Methods: A retrospective review was conducted of 1,159 patients who underwent inguinal hernia surgery at Servergazi State Hospital between January 1, 2021, and December 31, 2023. Data analyzed included patient demographics, hernia types, locations, surgical methods, and complications. Special hernias, including Amyand's, Littre's, and Richter's hernias, were specifically identified and reviewed. Results: Among the 1,159 patients, 113 were female (9.7%) and 1,046 were male (90.3%). The average age was 47.8 years for females and 58.6 years for males. Hernia types included 838 inguinal (72.3%), 267 femoral (23.1%), and 54 recurrent (4.6%). Specific hernias identified included 4 cases of Amyand's hernia (0.34%), 2 cases of Littre's hernia (0.17%), and 1 case of Richter's hernia (0.08%). Surgical approaches consisted of 83.7% open surgery and 16.3% laparoscopic procedures, with meshplasty performed in 96.5% of cases. Complications were infrequent: seroma in 3.9%, hematoma in 1.8%, wound infection in 2.8%, and recurrence in 0.4%. Specific hernias required additional procedures such as appendectomy for Amyand's hernia and diverticulectomy for Littre's hernia, with no complications reported during follow-up. Conclusion: Inguinal hernias often contain omental tissue, but special hernias like Amyand's (appendix), Littre's (Meckel’s diverticulum), and Richter's (intestinal wall) necessitate thorough examination. Amyand's hernia, which can range from incidental findings to acute appendicitis, benefits from mesh repair and appendectomy if needed. Littre’s hernia requires diverticulectomy in addition to hernia repair. Richter's hernia, presenting with varied symptoms, should be managed with direct inspection and appropriate repair. The increasing use of minimally invasive techniques may lead to a higher incidence of Richter's hernia. Tailoring surgical strategies to the type of hernia ensures optimal outcomes.