135 Patient Perceived Aetiology Of Abdominal Wall Hernia In The Modern Era: A Prospective Study

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Abstract Introduction Ventral hernias result from the interplay between predisposing and precipitating factors. Traditionally cited precipitating factors, - lifting, chronic cough, constipation and urinary obstruction have remained unchanged for centuries, despite major changes in work practice, healthcare and leisure activities. Aims This study correlated patient-perceived precipitating factors for hernia formation with patient demographics. Methods Patients presenting with ventral hernia, over an 18-month period, were interviewed to evaluate their interpretation of the factor(s) which precipitated their hernia formation using a detailed doctor-delivered questionnaire. Results Of 277 consecutive patients (mean age 55.7 years; 85.6% male) inguinal hernia was the most common subtype (66.1%), followed by umbilical (10.8%), and epigastric (10.5%). Occupational lifting, the most common precipitant, was cited by 43.3% of patients. The likelihood of occupational lifting related herniation increased with age (0.0395, p<0.0001) and was significantly higher amongst males (0.9195, p=0.021). Conversely, 25.6% believed that gym activity contributed to hernia development. Patients who cited gym activity as a precipitant were significantly younger (t-statistic=-6.25, p<0.05). There was a statistically significant correlation between age and patient-identified cause of hernia (F=10.735, p=0.01) with younger patients reporting gym activity (mean age=46 years) and pregnancy (mean age=36 years) as most likely contributing factors. Traditionally cited risk factors – cough, constipation and urinary obstruction were only cited by 4% of patients. Conclusions This study has identified an emerging cohort of younger patients presenting with hernias that they associate with gym related fitness pursuits. Traditionally reported precipitants may not be as relevant to the modern patient and may require re-evaluation.

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