herencia de la hernia inguinal
DESCRIPTION
hernia inguinalTRANSCRIPT
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REVIEW
The inheritance of groin hernia: a systematic review
J. Burcharth • H. C. Pommergaard •
J. Rosenberg
Received: 9 September 2012 / Accepted: 8 February 2013 / Published online: 20 February 2013
� Springer-Verlag France 2013
Abstract
Background Groin hernia has been proposed to be
hereditary; however, a clear hereditary pattern has not been
established yet. The purpose of this review was to analyze
studies evaluating family history and inheritance patterns
and to investigate the possible heredity of groin hernias.
Methods A literature search in the MEDLINE and Em-
base databases was performed with the following search
terms: genetics, heredity, multifactorial inheritance, inher-
itance patterns, sibling relations, family relations, and
abdominal hernia. Only English human clinical or register-
based studies describing the inheritance of groin hernias,
family history of groin hernias, or familial accumulation of
groin hernias were included.
Results Eleven studies evaluating 37,166 persons were
included. The overall findings were that a family history of
inguinal hernia was a significant risk factor for the devel-
opment of a primary hernia. A family history of inguinal
hernia showed a tendency toward increased hernia recur-
rence rate and significantly earlier recurrence. The included
studies did not agree on the possible inheritance patterns
differing between polygenic inheritance, autosomal domi-
nant inheritance, and multifactorial inheritance. Further-
more, the studies did not agree on the degree of penetrance.
Conclusion The literature on the inheritance of groin
hernias indicates that groin hernia is most likely an inher-
ited disease; however, neither the extent of familial accu-
mulation nor a clear inheritance pattern has yet been found.
In order to establish whether groin hernias are accumulated
in certain families and to what extent, large register studies
based on hernia repair data or clinical examinations are
needed.
Groin hernia repair (inguinal and femoral hernia) is among
the most commonly performed gastrointestinal surgical
procedures [1]. Emergency groin hernia surgery is associ-
ated with increased mortality, increased patient-related
morbidity, and increased hospital stay compared with
elective groin hernia procedures [2, 3]. Identifying patients
at high risk of developing groin hernia would therefore
provide the possibility of timely elective surgical inter-
vention, thus reducing the rate of emergency procedures. It
could also potentially make way for individualized surgical
methods in the future.
Keywords Inguinal hernia � Groin hernia � Risk factor �Inheritance � Systematic review
Introduction
Earlier proposed risk factors for developing groin hernias
are, for example, male gender [4], old age [5], patent
processus vaginalis [6], low body mass index [7], and high
intraabdominal pressure [8]. Knowledge of systemic col-
lagen diseases, such as cutis laxa [9], Marfan syndrome
[10], and Ehlers–Danlos syndrome [11], has revealed a
link to hernia formation. In particular, systemic collagen
subtype imbalance [12] and altered extracellular matrix
composition/degradation [13, 14] correlate to increased
occurrence of primary and recurrent hernia. Furthermore,
positive family history (i.e., the presence of hernia in
directly related close family members) has been proposed
as a predictor for development [15] as well as an increased
risk of recurrence of primary hernia [16].
J. Burcharth (&) � H. C. Pommergaard � J. Rosenberg
Department of Surgery, Center for Perioperative Optimization,
Herlev Hospital, University of Copenhagen, Herlev Ringvej 75,
2730, DK, Copenhagen, Denmark
e-mail: [email protected]
123
Hernia (2013) 17:183–189
DOI 10.1007/s10029-013-1060-4
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The purpose of this review was to analyze studies
evaluating the impact of positive family history and
inheritance patterns and thereby investigate the possible
heredity of groin hernias.
Methods
Literature search
Using the PRISMA [17, 18] guidelines, a systematic lit-
erature search was performed in February 2012 in MED-
LINE and Embase. To supply the strategic search, a
reference search in the obtained articles0 reference list was
done, as not all relevant studies are expected to be returned
only by relying on systematic database searches [19].
The aim of the literature search was to identify studies
describing the inheritance patterns of groin hernia and the
impact of positive family history and familial accumulation
of groin hernia.
The literature search in the MEDLINE database utilized
the Advanced Search feature with the following search terms:
genetics, heredity, multifactorial inheritance, inheritance
patterns, sibling relations, family relations, and abdominal
hernia as All Field and MeSH terms. The literature search in
Embase used the Multifield Advanced Search Function with
the same search terms. We did not apply further filtering in
order to enhance the possibilities of the search strategy.
Study selection criteria
Only human clinical or register-based studies describing
the inheritance of groin hernias, positive family history of
groin hernias, or familial accumulation of groin hernias
were included. Only studies published in English were
considered for inclusion.
The primary study outcome for this review was inheri-
tance patterns of groin hernia. The secondary study out-
come was determination of risk estimates odds ratio (OR),
relative risk (RR) of positive family history of groin her-
nias as a risk factor for groin hernia development. Studies
not evaluating the above mentioned (e.g., studies focusing
on specific gene-finding techniques) and case reports were
excluded. For the study selection process, see Fig. 1.
Initial abstract screening and full-text assessment
Titles and abstracts were assessed for eligibility by two
reviewers according to the study selection criteria. Any
uncertainties between the reviewers were settled by dis-
cussion until consensus. For the abstracts possibly suited
for inclusion in this systematic review, full manuscripts
were obtained and evaluated in detail.
Data extraction
The following were extracted from the included studies:
study design, study aims, population (patient material,
number, subgroups, and demographics), hernia type inves-
tigated, results, inheritance patterns when possible, risk
estimates (OR/RR in absolute numbers), and study con-
clusions. Data were extracted directly from the included
studies and discussed by both reviewers. Furthermore,
studies were evaluated for limitations and possible bias.
Results
A total of 1,023 possible studies were identified, and after
doublets were removed, the search strategy resulted in 712
studies possible for inclusion (Fig. 1). After screening of
title and abstract, 30 full-text manuscripts were selected
and assessed for eligibility. After application of study cri-
teria, 11 studies evaluating a total of 37,166 persons
remained, which were included in this systematic review
(Fig. 1). All of the included studies evaluated inguinal
hernias and none evaluated femoral hernias (Table 1).
Seven studies evaluated primary hernias [15, 16, 20–24],
whereas the remaining four studies evaluated both primary
and recurrent hernias [25–28]. Nine studies determined risk
estimates of a positive family history on the development
of an inguinal hernia. Two studies determined possible
inheritance patterns of inguinal hernias [23, 24].
Positive family history (Table 1)
Six studies evaluated the effect of a positive family history
in both adults and children including a total of 28,746
persons [15, 16, 20, 23, 25, 26]. However, the majority of
patients arise from a single prevalence study simply reg-
istering persons with self-reported first-degree family
members with hernias [20], leaving 1,338 persons from the
other clinical studies. The overall findings of these studies
were that a positive family history of inguinal hernia was a
significant risk factor for the development of a primary
hernia, with the highest risk being a RR 8.35 (CI 95 %
4.72–14.76, p \ 0.01) between male family members [15].
Moreover, a positive family history showed a tendency
toward a higher recurrence rate with an OR 8.43 (CI 95 %
0.91–78.40, p = 0.06) [25] and significantly earlier recur-
rence after the primary procedure [16].
Two studies evaluated the effects of a positive family
history in children [21, 24]. It was found that mothers and
girls more often were affected than mothers and sons and
that this effect was most pronounced when the daughters
had bilateral hernias [21]. Furthermore, it was shown that
all other first-degree relatives to a child with an inguinal
184 Hernia (2013) 17:183–189
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hernia had an increased relative risk [24]. The studies
showed that girls with sisters that had been operated for
inguinal hernia had a significantly increased risk of devel-
oping a hernia themselves of RR 17.8 (CI 95 % 6.9–46.3).
Twin studies (Table 1)
Two studies examined the hernia occurrence between
monozygotic (MZ) and dizygotic (DZ) twins and included
a total of 2,861 twin pairs [27, 28]. One study found that
MZ twins did not have an increased occurrence of inguinal
hernia compared with DZ twins [27], whereas the other
study found that MZ twins had a significantly higher fre-
quency of hernias than DZ and concluded that the differ-
ence was related to genetic factors [28]. Both of these twin
studies were large in size; however, the largest of the
studies did not specify what types of hernia that were
included in the study [28].
Inheritance patterns and penetrance (Table 1)
The studies evaluating inguinal hernia inheritance patterns
did not agree. Polygenic inheritance [21], autosomal dom-
inant with reduced penetrance [23], and multifactorial
inheritance [24] have been suggested. No studies have
reported indications of inguinal hernias being inherited
through simple inheritance patterns. Common for the
studies that addressed penetrance was a reporting of it as a
secondary finding despite its importance for the subject.
Discussion
This systematic review found that a positive family history
was a significant risk factor for development of primary
inguinal hernia. The suggested inheritance patterns in the
included studies differed between autosomal dominant,
Fig. 1 Flow diagram of study
selection
Hernia (2013) 17:183–189 185
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Ta
ble
1O
utc
om
eso
fth
ein
clu
ded
stu
die
s
Stu
dy
Po
pu
lati
on
,H
ern
ia
typ
e
Res
ult
sL
imit
atio
ns
Co
ncl
usi
on
s
Inh
erit
ance
Co
nco
rdan
ceR
isk
Mar
shal
l
etal
.[2
8]
2,5
37
twin
pai
rs
(ag
e2
–7
0y
ears
).
Her
nia
typ
e:n
s
ns
Mo
reM
Z
twin
sw
ith
her
nia
s
than
DZ
twin
s
(p=
0.0
2)
ns
Tw
inzy
go
sity
loo
sely
det
erm
ined
by
qu
esti
on
sto
rela
tiv
es(i
ncl
usi
on
bia
s,
reca
llb
ias)
.Z
yg
osi
tyte
stin
gp
erfo
rmed
on
44
twin
pai
rs
An
yd
iffe
ren
cein
con
cord
ance
reli
edo
n
gen
etic
fact
ors
Bak
win
etal
.[2
7]
32
4tw
inp
airs
(ag
e
5–
18
yea
rs).
Her
nia
typ
e:II
H
ns
No
dif
fere
nce
bet
wee
n
MZ
and
DZ
twin
s
ns
Inte
rvie
w-b
ased
dat
afr
om
mo
ther
s(r
ecal
l
bia
s).T
win
zyg
osi
tyd
eter
min
edp
artl
yb
y
clin
ical
exam
inat
ion
No
gen
etic
bas
isfo
rh
ern
ia
dev
elo
pm
ent
inch
ild
ren
Saw
agu
chi
etal
.[2
1]
1,7
23
chil
dre
n
(ag
e0
–1
2y
ears
).
Her
nia
typ
e:II
H
Mo
rep
ron
ou
nce
dfr
om
mo
ther
to
dau
gh
ter
than
mo
ther
toso
n
(p\
0.0
5)
ns
Bil
ater
alh
ern
ias
in
chil
dre
nco
rrel
ated
to
mo
ther
sw
ith
her
nia
s
(p\
0.0
5)
Inte
rvie
w-b
ased
dat
afr
om
par
ents
(rec
all
bia
s).
Fam
ily
dat
are
trie
ved
fro
mh
alf
of
the
incl
ud
edch
ild
ren
.N
oco
ntr
ol
gro
up
,
bac
kg
rou
nd
freq
uen
cies
of
IHb
ased
on
assu
mp
tio
ns
Po
lyg
enic
inh
erit
ance
wit
h
thre
sho
ld.
Mo
reli
kel
yth
at
fem
ales
hav
ep
osi
tiv
e
fam
ily
his
tory
of
her
nia
than
mal
es
Cze
izel
etal
.[2
2]
70
7p
aren
tso
f
chil
dre
nw
ith
CIH
.H
ern
ia
typ
e:C
IH
Fat
her
s/m
oth
ers
toch
ild
ren
(RR
2/R
R5
).B
roth
ers/
sist
ers
of
fem
ale
case
s(R
R3
.4/R
R7
.1).
Bro
ther
s/si
ster
so
fm
ale
case
s
(RR
3.6
/RR
5.3
)
ns
ns
Inte
rvie
w-b
ased
dat
afr
om
par
ents
(rec
all
bia
s).
Sta
tist
ical
sig
nifi
can
cen
ot
stat
ed
Mu
ltif
acto
rial
do
min
ant
inh
erit
ance
wit
hth
resh
old
.
Mo
ther
sm
ore
affe
cted
than
fath
ers.
Par
ents
less
affe
cted
than
sib
lin
gs
Go
ng
etal
.
[23]
34
0p
erso
ns
(31
9
mal
es,
21
fem
ales
).H
ern
ia
typ
e:II
H
Dir
ect
mal
eto
mal
etr
ansm
issi
on
in5
2%
of
fam
ilie
s
ns
ns
No
con
tro
lg
rou
p.
No
bac
kg
rou
nd
po
pu
lati
on
inci
den
ceo
fh
ern
ias.
No
kn
ow
led
ge
of
spo
nta
neo
us
her
nia
occ
urr
ence
inp
op
ula
tio
n
Au
toso
mal
do
min
ant
inh
erit
ance
wit
hre
du
ced
pen
etra
nce
Lie
met
al.
[26]
72
fem
ale
pat
ien
ts
(12
9co
ntr
ols
).
Her
nia
typ
e:IH
ns
ns
Po
siti
ve
fam
ily
his
tory
inp
atie
nts
com
par
ed
wit
hco
ntr
ol
gro
up
(OR
4.3
(CI
95
%
1.9
–9
.7))
Inte
rvie
w-b
ased
dat
a(r
ecal
lb
ias)
.T
he
deg
ree
the
rela
tiv
esh
adto
the
pat
ien
ts
no
td
efin
ed.N
ot
com
ple
tely
mat
ched
case
and
con
tro
lg
rou
ps
Po
siti
ve
fam
ily
his
tory
of
ing
uin
alh
ern
iais
ari
sk
fact
or
for
dev
elo
pm
ent
of
ing
uin
alh
ern
iain
fem
ales
Ak
inet
al.
[20]
27
,40
8m
ales
(ag
e
20
–2
2).
Her
nia
typ
e:IH
ns
ns
Fam
ily
his
tory
:(2
0.6
%
rep
ort
edfi
rst-
deg
ree
rela
tiv
esw
ith
her
nia
)
Inte
rvie
w-b
ased
dat
a(r
ecal
lb
ias)
.N
o
con
tro
lg
rou
p.
No
po
pu
lati
on
pre
val
ence
of
IHfo
rco
mp
aris
on
Hig
hfr
equ
ency
of
po
siti
ve
fam
ily
his
tory
amo
ng
IH
pat
ien
ts
Jon
eset
al.
[24]
2,2
68
chil
dre
n
(1,9
21
mal
es,
34
7fe
mal
es)
(ag
e0
–5
yea
rs).
Her
nia
typ
e:C
IH
Bro
ther
so
fm
ale
case
and
fem
ale
case
s(R
R5
.8,
RR
4.3
).S
iste
ro
f
mal
eca
sean
dfe
mal
eca
se(R
R
3.7
,R
R1
7.8
)
ns
ns
Mu
ltif
acto
rial
inh
erit
ance
wit
hth
resh
old
Jun
ge
etal
.
[25]
14
2p
atie
nts
(ag
e
18
–7
9y
ears
),
(91
.2%
mal
es).
Her
nia
typ
e:IH
ns
ns
Po
siti
ve
fam
ily
his
tory
inp
atie
nts
(OR
8.4
3
(CI
95
%0
.91
–7
8.4
0)
Inte
rvie
w-b
ased
fam
ily
dat
a(r
ecal
lb
ias)
.
No
con
tro
lg
rou
p.
No
td
efin
edth
ed
egre
e
the
rela
tiv
esh
adto
the
pat
ien
ts
Po
siti
ve
fam
ily
his
tory
fact
or
for
IH
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polygenic and multifactorial inheritance; however, all
suggested inheritance patterns were complex and no stud-
ies suggested simple monogenic inheritance. Neither did
the included studies agree on the degree of penetrance.
The included studies in this review are heterogenic and
differ somewhat in design, size, aim, and outcome. In five
of the included studies, positive familial history of hernia
or inheritance of hernia was typically a secondary finding
[15, 16, 20, 25, 26]. All of the included studies except one
[24] had a degree of recall bias, since recording of hernia
occurrence was based on interviews rather than actual
surgical data, register-based data, or clinical examinations.
Furthermore, a general problem in all of the studies except
three [15, 24, 26] was the lack of a comparative control
group, which reduced the possibility of transferring the
results to a wider demographic population. Some studies
lacked a clear definition of a positive family history
[15, 16, 23, 26]. This reduces the possibilities of deter-
mining the degree of inheritance, since it could not be
extracted from the studies whether affected relatives were
directly related (first degree) or more distantly related,
which may greatly complicate interpretation of the results.
Some studies were unclear in the calculation of the degree
of inheritance from the data or did not state whether results
were significant [16, 22, 25, 28]. In two of the included
studies [21, 26], it was not stated whether the data were
based on clinical examinations or surgical procedures, in
which case clinical observer bias cannot be excluded.
In the two included twin studies, the twin zygosity was
established by blood group analysis on a small subgroup of
the entire included study population and by opinions from
relatives, as to whether the siblings were MZ or DZ twins.
Thus, these methods may be neither rigorous nor consistent
enough to produce clear conclusions [27, 28]. However, in
the one study finding a higher concordance between MZ
twins compared with DZ twins, the results are interesting
since it is given that MZ twins have identical genomes, and
the fact that a larger fraction of MZ twins develops hernias
compared with DZ twins strongly points toward a genetic
aspect [28].
Besides the included studies in this review, a few case
studies have reported families with a hereditary predispo-
sition to inguinal hernias [29–34]. Together with the
studies in this review, the two main other studies suggested
that inheritance patterns are autosomal dominant inheri-
tance with incomplete penetrance and male influence
[23, 29, 30, 32, 33] and polygenic multifactorial inheri-
tance with a threshold [21, 22, 24, 34]. The strongest link
has been found between females with hernias; however, a
definite and clear inheritance pattern has not yet been
found. It is most likely that a possible inheritance pattern of
groin hernia is complex, and the level of penetrance of the
involved genes may play a major role. No studies haveTa
ble
1co
nti
nu
ed
Stu
dy
Po
pu
lati
on
,H
ern
ia
typ
e
Res
ult
sL
imit
atio
ns
Co
ncl
usi
on
s
Inh
erit
ance
Co
nco
rdan
ceR
isk
Lau
etal
.
[15]
70
9m
ale
pat
ien
ts
(ag
e5
2–
78
)(7
09
mal
eco
ntr
ols
).
Her
nia
typ
e:IH
ns
ns
Po
siti
ve
fam
ily
his
tory
risk
fact
or
for
IH
dev
elo
pm
ent
(p\
0.0
1,
RR
8.3
5
(CI
95
%)
4.7
2–
14
.76
)
Inte
rvie
w-b
ased
fam
ily
dat
a(r
ecal
lb
ias)
.
No
td
efin
edth
ed
egre
eth
ere
lati
ves
had
toth
ep
atie
nts
Po
siti
ve
fam
ily
his
tory
risk
fact
or
for
pri
mar
yin
gu
inal
her
nia
dev
elo
pm
ent
Jan
sen
etal
.[1
6]
75
pat
ien
ts(a
ge
18
–7
4).
Her
nia
typ
e:IH
ns
ns
Po
siti
ve
fam
ily
his
tory
risk
fact
or
for
earl
ier
on
set
of
recu
rren
ce
Inte
rvie
w-b
ased
fam
ily
dat
a(r
ecal
lb
ias)
Pat
ien
tsw
ith
afa
mil
yh
isto
ry
hav
ere
curr
ence
ata
yo
un
ger
age
Ns
no
tst
ated
,M
Zm
on
ozy
go
te,D
Zd
izy
go
te,C
IHco
ng
enit
alin
gu
inal
her
nia
,II
Hin
dir
ect
ing
uin
alh
ern
ias,
IHin
gu
inal
her
nia
,R
Rre
lati
ve
risk
,O
Ro
dd
sra
tio
,C
I9
5%
95
%co
nfi
den
cein
terv
al
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reported on possible hereditary predisposition of other
types of groin hernia (e.g., femoral hernias) than inguinal
hernias, most likely due to their rarity compared with
inguinal hernias.
In determining a possible inheritance pattern of a disease
as common as inguinal hernias, several elements need to be
addressed. Besides distinguishing between inguinal and
femoral hernias, it may be relevant to separate analyses of
inguinal hernias for direct and indirect inguinal hernias,
since the two hernia types might have different etiologies.
It is known that children predominantly develop indirect
inguinal hernias, whereas adults have both direct and
indirect inguinal hernias [35]. It has been hypothesized that
a direct inguinal hernia is caused by a local collagen
weakness, whereas the indirect hernia is due to a congenital
malformation (persistent processus vaginalis) [36, 37]. This
possible difference between the indirect and the direct
inguinal hernia may suggest that the children and the adult
hernia have different etiologies. The included studies in
this review are based on data from children as well as
adults and include both direct and indirect inguinal hernias
in their datasets, which may reduce the possibility of
retrieving a common conclusion on inheritance pattern
among the studies. As seen in Table 1, gender seems to be
an important factor for the development of groin hernias.
In general, contradictory results were seen among the
included studies regarding gender influence on the risk of
developing an inguinal hernia. Some studies found that
female members of affected families had higher risks than
males [21, 22, 24, 26], whereas other studies found high
risk among males for developing inguinal hernias [15, 23,
25]. Due to the heterogeneity of the study designs as well
as the disagreement of the results, no final conclusion
regarding the gender influence can be made on the basis of
the included studies. Furthermore, it is important to be
aware of the amount of male and female cases in the
selected families, since inguinal hernias are more common
among males. Therefore, families with many males may be
influenced by a high spontaneous frequency of inguinal
hernias. Finally, it should be clarified if any of the affected
family members suffered from a collagen disease that may
predispose to hernias. The fact that the included studies
suggested different complex possible inheritance patterns
and varying degrees of penetrance points out the possible
complexity of this area. The fact that inguinal hernias
might are inherited with reduced or varying penetrance
greatly increases the requirements for study designs and
study size, since the possibility of locating a strong familial
connection reduces with low genetic penetrance.
In finding a possible positive family history of groin
hernia, several factors need to be considered. The design of
the study should be as concise and methodically strict
as possible. Preferably, it should be a large-scale study,
including persons over a geographically wide area so that
the data are representative of the general population. Sev-
eral of the studies lack this element. Furthermore, a precise
definition of a positive family history should be used. The
authors recommend that the definition should be restricted
to include only first-degree family members. The studies
should also be based on incidence data rather than preva-
lence data, given that there otherwise will be a risk of
misjudging the potential familial relation. Thus, the risk
estimates from prevalence data are limited to the study
period only, whereas lifetime risk is evaluated in incidence
data. Finally, the data should be based on safe measureable
hernia data such as operation charts instead of interview
data or clinical examinations, in order to eliminate possible
recall bias and clinical observer bias. The strongest of the
included studies make use of register-based repair data,
however, only focusing on indirect congenital inguinal
hernias in children aged 0–5 years and their siblings [24].
None of the other included studies make use of register-
based data.
The possible determination of hernia inheritance and
thereby identification of high-risk patients may have several
clinical implications. It is known that up to 5 % of inguinal
hernias and 40 % of femoral hernias require acute surgery
due to hernia incarceration [2, 3]. Mortality rates in elective
groin hernia procedures are reported to be less than 0.5 %
[38], whereas emergency groin hernia repairs are associated
with a mortality rate of 2–8 % [39, 40]. A possible method
for identification of high-risk patients would allow timely
control and intervention before the hernia is presented
acutely. By establishing patients at high risk and possible
inheritance patterns, it may be possible to reduce mortality
and complications by having particular focus on these
patients. From a clinical point of view, knowledge of these
high-risk patients may potentially result in different treat-
ment strategies, for example, with the use of larger meshes
and more frequent postoperative follow-up, since patients
with a positive family history have a documented tendency
of overall higher recurrence rate [25] and a significantly
higher risk of earlier recurrence [16].
Conclusion
In conclusion, the literature on the inheritance of groin
hernias indicates that groin hernias most probably are
inherited. However, due to the heterogeneity of the inclu-
ded studies, no final conclusion can be made at this point,
on either the extent of familial accumulation or an inheri-
tance pattern. In order to establish whether groin hernias
are hereditary and to what extent, large register studies
based on hernia repair data or clinical examinations are
needed. Furthermore, larger-scale studies examining the
188 Hernia (2013) 17:183–189
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inguinal hernia concordance of MZ twins compared with
DZ twins should be performed.
Conflict of interest None.
References
1. Kingsnorth A, LeBlanc K (2003) Hernias: inguinal and inci-
sional. Lancet 362:1561–1571
2. Dahlstrand U, Wollert S, Nordin P, Sandblom G, Gunnarsson U
(2009) Emergency femoral hernia repair: a study based on a
national register. Ann Surg 249:672–676
3. Nilsson H, Stylianidis G, Haapamaki M, Nilsson E, Nordin P
(2007) Mortality after groin hernia surgery. Ann Surg 245:656–
660
4. Phillips W, Goldman M (2004) Groin Hernia. In: Raftery J, Mant
J, Simpson S (eds) Stevens A. Radcliffe publ, Health care needs
assessment, pp 671–721
5. Ruhl CE, Everhart JE (2007) Risk factors for inguinal hernia
among adults in the US population. Am J Epidemiol 165:1154–
1161
6. van Veen RN, van Wessem KJP, Halm JA, Simons MP, Plaisier
PW, Jeekel J, Lange JF (2007) Patent processus vaginalis in the
adult as a risk factor for the occurrence of indirect inguinal
hernia. Surg Endosc 21:202–205
7. Rosemar A, Angeras U, Rosengren A (2008) Body mass index
and groin hernia: a 34-year follow-up study in Swedish men. Ann
Surg 247:1064–1068
8. Ponka J (1980) Hernias of the abdominal wall. WB Saunders,
Philadelphia, pp 264–273
9. Ringpfeil F (2005) Selected disorders of connective tissue:
pseudoxanthoma elasticum, cutis laxa, and lipoid proteinosis.
Clin Dermatol 23:41–46
10. Pyeritz RE, McKusick VA (1979) The Marfan syndrome: diag-
nosis and management. N Engl J Med 300:772–777
11. Liem MS, van der Graaf Y, Beemer FA, van Vroonhoven TJ
(1997) Increased risk for inguinal hernia in patients with Ehlers-
Danlos syndrome. Surgery 122:114–115
12. Henriksen N, Yadete DH, Sorensen LT, Agren MS, Jorgensen LN
(2011) Connective tissue alteration in abdominal wall hernia. Br J
Surg 98:210–219
13. Abrahamson J (1998) Etiology and pathophysiology of primary
and recurrent groin hernia formation. Surg Clin North Am
78:953–972
14. Bellon JM, Bajo A, Ga-Honduvilla N, Gimeno MJ, Pascual G,
Guerrero A et al (2001) Fibroblasts from the transversalis fascia
of young patients with direct inguinal hernias show constitutive
MMP-2 overexpression. Ann Surg 233:287–291
15. Lau H, Fang C, Yuen WK, Patil NG (2007) Risk factors for
inguinal hernia in adult males: a case-control study. Surgery
141:262–266
16. Jansen PL, Klinge U, Jansen M, Junge K (2009) Risk factors for
early recurrence after inguinal hernia repair. BMC Surg 9:18
17. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred
reporting items for systematic reviews and meta-analyses: the
PRISMA statement. PLoS Med 21(6):e1000097
18. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC,
Ioannidis JPA et al (2009) The PRISMA statement for reporting
systematic reviews and meta-analyses of studies that evaluate
health care interventions: explanation and elaboration. J Clin
Epidemiol 62:e1–e34
19. Greenhalgh T, Peacock R (2005) Effectiveness and efficiency of
search methods in systematic reviews of complex evidence: audit
of primary sources. BMJ 331:1064–1065
20. Akin ML, Karakaya M, Batkin A, Nogay A (1997) Prevalence of
inguinal hernia in otherwise healthy males of 20 to 22 years of
age. J R Army Med Corps 143:101–102
21. Sawaguchi S, Matsunaga E, Honna T (1975) A genetic study on
indirect inguinal hernia. Jpn J Hum Genet 20:187–195
22. Czeizel A, Gardonyi J (1979) A family study of congenital
inguinal hernia. Am J Med Genet 4:247–254
23. Gong Y, Shao C, Sun Q, Chen B, Jiang Y, Guo C et al (1994)
Genetic study of indirect inguinal hernia. J Med Genet 31:187–
192
24. Jones ME, Swerdlow J, Griffith M, Goldacre MJ (1998) Risk of
congenital inguinal hernia in siblings: a record linkage study.
Paediatr Perinat Epidemiol 12:288–296
25. Junge K, Rosch R, Klinge U, Schwab R, Peiper C, Binnebosel M
et al (2006) Risk factors related to recurrence in inguinal hernia
repair: a retrospective analysis. Hernia 10:309–315
26. Liem MS, van der Graaf Y, Zwart RC, Geurts I, van Vroonhoven
TJ (1997) Risk factors for inguinal hernia in women: a case-
control study. The Coala Trial Group. Am J Epidemiol 146:721–
726
27. Bakwin H (1971) Indirect inguinal hernia in twins. J Pediatr Surg
6:165–168
28. Marshall AG, Hutchinson EO, Honisett J (1962) Heredity in
common diseases. A retrospective survey of twins in a hospital
population. BMJ 1:1–6
29. West L (1936) Two pedigrees showing inherited predisposition to
hernia. J Hered 27:449–455
30. Montague M (1942) A case of familial inheritance of oblique
inguinal hernia. J Hered 33:355
31. Akbulut S, Cakabay B, Sezgin A (2010) A familial tendency for
developing inguinal hernias: study of a single family. Hernia
14:431–434
32. Weimer BR (1949) Congenital inheritance of inguinal hernia.
J Hered 40:219
33. Smith M (1965) Familial inguinal hernia. Surgery 57:809–812
34. Carter CO (1969) Genetics of common disorders. Br Med Bull
25:52–57
35. Ein SH, Njere I, Ein A (2006) Six thousand three hundred sixty-
one pediatric inguinal hernias: a 35-year review. J Pediatr Surg
41:980–986
36. Wagh PV, Leverich AP, Sun CN, White HJ, Read RC (1974)
Direct inguinal herniation in men: a disease of collagen. J Surg
Res 17:425–433
37. van Wessem KJP, Simons MP, Plaisier PW, Lange JF (2003) The
etiology of indirect inguinal hernias: congenital and/or acquired?
Hernia 7:76–79
38. Bay-Nielsen M, Kehlet H, Strand L, Malmstrøm J, Andersen FH,
Wara P et al (2001) Quality assessment of 26,304 herniorrhaphies
in Denmark: a prospective nationwide study. Lancet 358:1124–
1128
39. Kjaergaard J, Bay-Nielsen M, Kehlet H (2010) Mortality
following emergency groin hernia surgery in Denmark. Hernia
14:351–355
40. Alani A, Page B, O’Dwyer PJ (2006) Prospective study on the
presentation and outcome of patients with an acute hernia. Hernia
2006:62–65
Hernia (2013) 17:183–189 189
123