Prevalence of occult femoral hernias in women undergoing inguinal hernioplasty: a statistical analysis

Abstract

Introduction. Occult femoral hernias (OFH) are a “hidden” type of hernia that are difficult to identify through clinical examination but have important medical implications. Considering that typical femoral hernias occur about four times more frequently in women, this study aimed to evaluate the sex-related distribution of occult femoral hernia (OFH) among patients undergoing inguinal hernioplasty, and to determine the prevalence of OFH in women with inguinal hernia, emphasizing the importance of systematic assessment. Material and methods. Bibliographic sources published within the last 15 years and indexed in MEDLINE, PubMed, Web of Science, Scopus, ScienceDirect, Google Scholar, and ResearchGate were systematically reviewed and synthesized. The study selection process followed the standard PRISMA methodology. Based on the included studies, an integrative evaluation of OFH incidence was conducted in a cumulative cohort of 9022 patients who underwent surgical procedures for inguinal hernioplasty. Statistical analysis was performed using IBM SPSS Statistics (v.2025, IBM Corp.). The Wald method was used to calculate 95% CIs, and statistical significance was evaluated with the binomial test. The relationships between categorical variables were analyzed using the chi-square (χ²) test. Results. Analysis of the cumulative cohort of 9022 patients revealed an overall prevalence of occult femoral hernias of 11.84%. The χ² test highlighted a statistically significant relationship between sex and OFH, with a female-to-male odds ratio of 4.26:1 (OR = 4.26; 95% CI: 3.1–5.6; p < 0.001). Further statistical analysis using the Wald method and the binomial test estimated an OFH prevalence of 18.1% among women with inguinal hernia (18.1%; 95% CI, 15.8–20.6 %, p < 0.001). Conclusion. These findings support systematic evaluation for the potential presence of an occult femoral hernia in all women scheduled for inguinal hernioplasty. Considering the 4.26-fold higher relative risk of occult hernias in women compared to men, and an estimated prevalence of 18.1% among female patients, our results imply that 1 in 5 women presenting with an inguinal hernia could have a concomitant OFH. Failure to detect OFH may compromise surgical outcomes, highlighting the potential of this preventive approach to improve prognosis and reduce post-herniorrhaphy recurrence in women.