ORIGINAL RESEARCH
Abdominal Surgery
doi: 10.25005/2074-0581-2026-28-2-434-444
THE RISK FACTORS OF INGUINAL HERNIA WITH OBSTRUCTION: A STUDY AT TERTIARY CARE HOSPITAL IN INDONESIA

V.P. PERDANA1, E. RACHMI2, S. MUNIR3,4

1Medical Doctor Profession Program, Faculty of Medicine, Universitas Mulawarman, Samarinda, Indonesia
2Department of Anatomy, Faculty of Medicine, Universitas Mulawarman, Samarinda, Indonesia
3Department of Surgery, Faculty of Medicine, Universitas Mulawarman, Samarinda, Indonesia
4Department of Surgery, A.W. Sjahranie State Hospital, Samarinda, Indonesia

Objective: This study investigated the correlation between the incidence of obstruction of inguinal hernia and several predictive factors.

Methods: This research was a cross-sectional observational study, conducted at a tertiary care hospital in East Kalimantan, Indonesia. A total of 107 patients with inguinal hernias were selected for the study using purposive sampling method. Data on age, location, and recurrence were obtained from medical records, while body mass index (BMI), body fat, and lean body mass (LBM) were calculated. Bivariate analysis was conducted using a chi-square or Fisher test, and a significance level of p-value less than 0.05 was applied.

Results: The study's findings revealed that 42.1% of patients had an inguinal hernia with obstruction. Obstruction of inguinal hernia was found to be associated with the age group of 18 to 65 years (p=0.026; OR=2,703), direct inguinal hernia (p=0.002; OR=14,043), and LBM of >47 kg (p=0.020; OR=2,921). Further analysis showed that only a LBM of >47 kg could predict the incidence of obstruction in indirect inguinal hernias (p=0.001; OR=6,786).

Conclusion: Inguinal hernia patients who were 18 to 65 years of age, had direct inguinal hernia, and LBM of >47 kg, experienced a greater risk of developing obstruction. The specific risk factor for obstruction in the indirect inguinal hernia type was a LBM >47 kg.

Keywords: Inguinal hernia with obstruction, lean body mass, body mass index, body fat, location of inguinal hernia.

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References
  1. Abebe MS, Tareke AA, Alem A, Debebe W, Beyene A. Worldwide magnitude of inguinal hernia: Systematic review and meta-analysis of population-based studies. SAGE Open Med. 2022;10:1-9. https://doi.org/10.1177/20503121221139150
  2. Beard JH, Ohene-Yeboah M, DeVries CR, Schecter WP. Hernia and hydrocele. In: Debas HT, Donkor P, Gawande A, Jamisaon DT, Kruk ME, Mock CN, eds. Essential Surgery. 3rd ed. Washington, D.C.: World Bank Group; 2015:151-72. https://doi. org/10.1596/978-1-4648-0346-8_ch9
  3. Köckerling F, Simons MP. Current concepts of inguinal hernia repair. Visc Med. 2018;34(2):145-50. https://doi.org/10.1159/000487278
  4. Danish A. Incarcerated right inguinal hernia containing sigmoid colon: An unusual case report. Int J Surg Case Rep. 2022;95:107237. https://doi.org/10.1016/j. ijscr.2022.107237
  5. Kulacoglu H. Current opinions in inguinal hernia emergencies: A comprehensive review of related evidences. Int J Abdom Wall Hernia Surg. 2023;6(3):136-58. https://doi.org/10.4103/ijawhs.IJAWHS_30_23
  6. Zhou J, Yuan X. Establishment of a risk prediction model for bowel necrosis in patients with incarcerated inguinal hernia. BMC Med Inform Decis Mak. 2024;24(1):1-16. https://doi.org/10.1186/s12911-024-02440-3
  7. Gallagher D, Heymsfield SB, Heo M, Jebb SA, Murgatroyd PR, Sakamoto Y. Healthy percentage body fat ranges: An approach for developing guidelines based on body mass index. Am J Clin Nutr. 2000;72(3):694-701. https://doi. org/10.1093/ajcn/72.3.694
  8. Tahari AK, Chien D, Azadi JR, Wahl RL. Optimum lean body formulation for correction of standardized uptake value in PET imaging. J Nucl Med. 2014;55(9):1481-4. https://doi.org/10.2967/jnumed.113.136986
  9. Sharma A, Khanna R, Meena RN, Mishra SP, Khanna S. An obstructed inguinal hernia with maldescended testis as content in an adult male: A case report. Am- rita J Med. 2024;20(1):38-41. https://doi.org/10.4103/AMJM.AMJM_70_23
  10. Ozbagriacik M, Bas G, Basak F, Sisik A, Acar A, Kudas I, et al. Management of strangulated abdominal wall hernias with mesh, early results. North Clin Istanb. 2015;2(1):26-32. https://doi.org/10.14744/nci.2015.03522
  11. Williams N, O'Connel R, McCaskie AW. Intestinal obstruction. In: Bailey & Love's Short Practice of Surgery. 27th ed. Boca Raton: Taylor and Francis Group;2018:1280-98. https://doi.org/10.1201/9781315111087
  12. Poulose BK, Carbonell AM, Rosen MJ. Hernias. In: Townsend CM, Evers BM, Beuchamps RD, Mattox KL, eds. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 21st ed. Amsterdam: Elsevier; 2022:1144-72. https://doi.org/10.1046/j.1445-2197.2002.2362d.x
  13. Kamat M, Singh N, Nattey K. A rare encounter of obstructed direct inguinal hernia of sliding variety. Int J Surg Case Rep. 2018;49:209-14. https://doi.org/10.1016/j. ijscr.2018.06.025
  14. Mai S, Cai J, Li L. Factors associated with access to healthcare services for older adults with limited activities of daily living. Front Public Health. 2022;10:1-10. https://doi.org/10.3389/fpubh.2022.921980
  15. Gammack JK. Physical activity in older people. Mo Med. 2017;114(2):105-9.
  16. Gunawan IMK, Saraswati PAI, Putra PMGA. Relationship between obesity with risk of obstruction in lateral inguinal hernia. Int J Health Med Sci. 2020;3(1):35- 41. https://doi.org/10.31295/ijhms.v3n1.124
  17. Ali MA, Abedi E, Hagbevor I, Kyei MY. Bilateral female inguinal hernia repair in margaret marquart catholic hospital and review of literature. J West Afr Coll Surg. 2022;12(2):47-52. https://doi.org/10.4103/jwas.jwas_10_21
  18. Wani I. Two indirect sacs and one canal of Nuck in female inguinal hernia: A case report. J Med Case Rep. 2025;19(1):1-4. https://doi.org/10.1186/s13256-025- 05142-0
  19. Nikolovski A, Misimi S, Minova E. Incarcerated multiple recurrent inguinal hernia with incidental finding of textiloma in the abdominal wall from previous hernia repair. Radiol Case Rep. 2022;17(3):914-7. https://doi.org/10.1016/j. radcr.2022.01.001
  20. Ooe Y, Horikawa N, Miyanaga S, Kobiyama R, Iida Y, Kanamoto A, et al. Management of an obstructed recurrent inguinal hernia using a hybrid method: A case report. BMC Surg. 2021;21(1):1-5. https://doi.org/10.1186/s12893-021- 01069-7
  21. Merali N, Verma A, Davies T. An innovative repair for a re-recurrence of an incarcerated inguinal hernia. Ann R Coll Surg Engl. 2014;96(8):18-9. https://doi. org/10.1308/003588414X13946184903081
  22. Bharata BS, Triarta GB. The relationship between obesity and obstruction risk of lateral inguinal hernia at Negara general hospital in 2019-2020. Int J Res Med Sci. 2020;8(12):4247-50. https://doi.org/10.18203/2320-6012.ijrms20205298
  23. Shrestha S, Upadhyay PK. Prevalence of obesity in inguinal hernia repair patients in a tertiary care center. J Nepal Med Assoc. 2021;59(234):156-9. https://doi. org/10.31729/jnma.5636
  24. Samimian S, Khaleghdoost T, Ashraf A, Hakimi H. Effect of body mass index on intra-abdominal pressure in patients hospitalized in ICUs. Med Res J. 2021;6(1):16-20. https://doi.org/10.3390/life13020330
  25. Mohan S, Lim ZY, Chan KS, Shelat VG. Impact of obesity on clinical outcomes of patients with intra-abdominal hypertension and abdominal compartment syndrome. Life (Basel). 2023;13(2):330. https://doi.org/10.3390/life13020330
  26. Pomeroy E, Macintosh A, Wells JCK, Cole TJ, Stock JT. Relationship between body mass, lean mass, fat mass, and limb bone cross-sectional geometry: Implications for estimating body mass and physique from the skeleton. Am J Phys Anthropol. 2018;166(1):56-69. https://doi.org/10.1002/ajpa.23398
  27. Tromaras K, Zaras N, Stasinaki AN, Mpampoulis T, Terzis G. Lean body mass, muscle architecture and powerlifting performance during preseason and in competition. J Funct Morphol Kinesiol. 2024;9(2):89. https://doi.org/10.3390/ jfmk9020089
  28. Wang DXM, Yao J, Zirek Y, Reijnierse EM, Maier AB. Muscle mass, strength, and physical performance predicting activities of daily living: A meta-analysis. J Ca- chexia Sarcopenia Muscle. 2020;11(1):3-25. https://doi.org/10.1002/jcsm.12502
  29. Lin Z, Shi G, Liao X, Huang J, Yu M, Liu W, et al. Correlation between sedentary activity, physical activity and bone mineral density and fat in America: National Health and Nutrition Examination Survey, 2011-2018. Sci Rep. 2023;13(1):1-9. https://doi.org/10.1038/s41598-023-35742-z
  30. Akai K, Nagai K, Tsuji S, Hirose K, Maruyama D, Matsuzawa R, et al. Association between bone quality and physical activity in community-dwelling older adults. Geriatrics (Basel). 2024;9(3):62. https://doi.org/10.3390/geriatrics9030062
  31. Dietze-Hermosa M, Hitchcock R, Nygaard IE, Shaw JM. Intra-abdominal pressure and pelvic floor health: Should we be thinking about this relationship differently? Female Pelvic Med Reconstr Surg. 2020;26(7):409-14. https://doi.org/10.1097/ spv.0000000000000799
  32. Gennaro JD de, Gennaro CK de, Shaw JM, Petelenz TJ, Nygaard IE, Hitchcock RW. The relationship between intra-abdominal pressure and body acceleration during exercise. Female Pelvic Med Reconstr Surg. 2017;23(4):1-7. https://doi. org/10.1097/spv.0000000000000523
  33. Kawabata M, Shima N. Interaction of breathing pattern and posture on abdominal muscle activation and intra-abdominal pressure in healthy individuals: A comparative cross-sectional study. Sci Rep. 2023;13(1):1-9. https:// doi.org/10.1038/s41598-023-37629-5
  34. Soucasse A, Jourdan A, Edin L, Gillion J-F, Masson C, Bege T. A better understanding of daily life abdominal wall mechanical solicitation: Investigation of intra- abdominal pressure variations by intragastric wireless sensor in humans. Med Eng Phys. 2022;104:103813. https://doi.org/10.1016/j.medengphy.2022.103813
  35. Adde HA, van Duinen AJ, Oghogho MD, Dunbar NK, Tehmeh LG, Hampaye TC, et al. Impact of surgical infrastructure and personnel on volume and availability of essential surgical procedures in Liberia. BJS Open. 2020;4(6):1246-55. https:// doi.org/10.1002/bjs5.50349
  36. Dare AJ, Lee KC, Bleicher J, Elobu AE, Kamara TB, Liko O, et al. Prioritizing surgical care on National Health Agendas: A qualitative case study of Papua New Guinea, Uganda, and Sierra Leone. PLoS Med. 2016;13(5):1-25. https://doi.org/10.1371/ journal.pmed.1002023
  37. Jhunjhunwala R, Venkatapuram S. How should we prioritise global surgery? A capabilities approach argument for the place of surgery within every health system. BMJ Glob Health. 2023;8(11):1-5. https://doi.org/10.1136/ bmjgh-2023-013100
  38. Silva-Aravena F, Morales J, Jayabalan M, Rana ME, Gutiérrez-Bahamondes JH. Dynamic surgical prioritization: A machine learning and XAI-based strategy. Technologies (Basel). 2025;13(2):1-20. https://doi.org/10.3390/ technologies13020072

Authors' information:

Perdana Vivia Putri,
Bachelor of Medicine, Medical Doctor Profession Program, Faculty of Medicine, Universitas Mulawarman
Researcher ID: MXL-9747-2025
ORCID ID: 0009-0001-0171-5409
E-mail: viviaaaputri@gmail.com

Rachmi Eva,
Doctor of Medical Sciences, Associate Professor of Biomedicine, Department of Anatomy, Faculty of Medicine, Universitas Mulawarman
Researcher ID: MXL-9708-2025
Scopus ID: 57214753779
ORCID ID: 0000-0003-2945-5001
E-mail: e.rahmi@fk.unmul.ac.id

Munir Sirajul,
General Surgeon, Lecturer, Department of Surgery, Faculty of Medicine, Universitas Mulawarman; Practitioner, A.W. Sjahranie State Hospital
Researcher ID: MXL-9932-2025
ORCID ID: 0009-0006-1147-3868
E-mail: surgeon.srm@gmail.com

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Rachmi Eva
Doctor of Medical Sciences, Associate Professor of Biomedicine, Department of Anatomy, Faculty of Medicine, Universitas Mulawarman

Jalan Kerayan, Kampus Gunung Kelua, Samarinda, East Kalimantan, Indonesia (1038)75119, Republic of Indonesia, East Kalimantan, Samarinda, Jalan Ker- ayan

Tel.: +62 (811) 5800866

E-mail: e.rahmi@fk.unmul.ac.id


This work is licensed under a Creative Commons Attribution 4.0 International License.

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