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.
