Hernias are among the most common conditions encountered in general surgery and continue to pose a significant health burden due to their high prevalence and potential for severe complications [1]. A hernia is defined as the protrusion of an organ or tissue through a weakness in the abdominal wall. The lifetime risk of developing an abdominal wall hernia is approximately 27% in men and 3% in women, highlighting marked gender variation in occurrence [2]. Inguinal hernias are the most common type, followed by femoral, umbilical, epigastric, and incisional hernias, each presenting with distinct etiological factors and clinical features [3].Although many hernias remain asymptomatic for long periods, complications such as incarceration, intestinal obstruction, and strangulation can occur at any time and may rapidly progress to life-threatening situations if not managed promptly [4]. Strangulation, which results from compromised blood supply to the herniated bowel, carries a high risk of ischemia, gangrene, sepsis, and mortality if surgical intervention is delayed [5]. Femoral hernias, though less frequent, are particularly notorious for early strangulation, especially in elderly women [6].Various patient-related factors influence the development and progression of hernia complications. Chronic cough, constipation, heavy lifting, obesity, pregnancy, and other conditions that increase intra-abdominal pressure contribute significantly to the risk of complications [7]. Comorbidities such as diabetes, chronic obstructive pulmonary disease, and malnutrition adversely affect surgical outcomes and increase the likelihood of emergency presentations.In developing countries, including India, late presentation is common due to limited awareness, financial constraints, and inadequate access to surgical care, resulting in a higher proportion of complicated hernias requiring emergency surgery [8]. Such emergency repairs are associated with increased rates of bowel resection, postoperative complications, longer hospital stays, and higher costs compared to elective repairs [9].Understanding the pattern of hernia types and their complications in a specific institution is essential for improving early diagnosis, optimizing surgical management, and reducing preventable morbidity. Therefore, this study aims to evaluate the types of hernias presenting to our institution, analyze their complications, and identify associated clinical characteristics to guide better patient care and outcomes [10]. This study aimed to analyze the age and sex distribution, types, laterality, and postoperative complications of inguinal hernia in a clinical cohort.

Study design: Prospective observational cohort study. Period of study: 2 years Place of Study: Department of General Surgery, Meenakshi Medical College , kanchipuram.Study Population: Patients presenting to the surgical OPD/emergency with a clinical diagnosis of inguinal hernia (direct, indirect, recurrent, bilateral, pantaloon) including complicated presentations (incarcerated, obstructed, strangulated). Sample size: 200 patients (as specified by the protocol). Inclusion Criteria: 1. Patients clinically diagnosed with any type of abdominal wall hernia, including: • Inguinal hernia (direct, indirect, bilateral, recurrent, pantaloon) • Femoral hernia • Umbilical hernia • Epigastric hernia • Incisional hernia • Ventral hernia • Complicated hernias (incarcerated, obstructed, or strangulated) 2. All adult patients ≥ 18 years presenting to the hospital during the study period. 3. Patients willing to participate in the study and able to provide informed written consent. 4. Both elective and emergency hernia cases. Exclusion Criteria: 1. Children < 18 years of age. 2. Patients with hernias associated with: • Ascites • Peritoneal dialysis • Connective tissue disorders (e.g., Marfan syndrome, Ehlers–Danlos syndrome) 3. Pregnant and lactating women. 4. Recurrent hernias previously repaired with mesh infection or requiring specialized reconstructive procedures not covered in the study protocol. 5. Patients with severe systemic illness where surgery cannot be performed safely (e.g., uncontrolled cardiac disease, severe respiratory failure). 6. Patients unwilling to participate or unable to provide informed consent. Study Variable: • Age • Sex • Type of Hernia • Laterality • Duration of Hernia Statistical Analysis: For statistical analysis, data were initially entered into a Microsoft Excel spreadsheet and then analyzed using SPSS (version 27.0; SPSS Inc., Chicago, IL, USA) and GraphPad Prism (version 5). Numerical variables were summarized using means and standard deviations, while Data were entered into Excel and analyzed using SPSS and GraphPad Prism. Numerical variables were summarized using means and standard deviations, while categorical variables were described with counts and percentages. Two-sample t-tests were used to compare independent groups, while paired t-tests accounted for correlations in paired data. Chi-square tests (including Fisher’s exact test for small sample sizes) were used for categorical data comparisons. P-values ≤ 0.05 were considered statistically significant.

Table 1: Distribution of Types of Inguinal Hernias across Age Groups Age Group Direct Inguinal Hernia Indirect Inguinal Hernia Recurrent Inguinal Hernia Bilateral Inguinal Hernia Pantaloon Hernia Total Cases < 40 years 6 46 1 2 4 59 40–60 years 27 72 5 4 14 122 > 60 years 21 28 6 8 3 66 Table 2: Age-Wise Distribution of Inguinal Hernia Patients (N = 200) Age Group (years) Number of Patients Percentage (%) < 40 years 52 26% 40–60 years 99 49.50% > 60 years 49 24.50% Total 200 100% Table 3: Distribution of Types and Laterality of Inguinal Hernia (N = 200) Category Number of Patients Percentage (%) Direct inguinal hernia 54 0.27 Indirect inguinal hernia 146 0.68 Recurrent inguinal hernia 12 0.06 Right inguinal hernia 139 0.695 Left inguinal hernia 61 0.305 Bilateral inguinal hernia 16 0.08 Table 4: Distribution of Hernia Type and Laterality among Female Patients Parameter Number of Patients Percentage (%) Type of Hernia in Female Patients (n = 4) Direct inguinal hernia 1 25% Indirect inguinal hernia 3 75% Laterality in Female Patients Right inguinal hernia 4 100% Left inguinal hernia 0 0% Table 5: Distribution of Postoperative Complications (n = 200) Complication Number of Cases Percentage (%) Seroma 25 17.60% Hematoma 13 9% Wound Infection 9 6.70% Inguinodynia 14 10% Sensory Disturbance 27 19.40% Recurrence 2 1.40% Orchitis 3 1.70% Testicular Atrophy 1 0.70% Hydrocele 1 0.70% Entero-cutaneous Fistula 1 0.70% Urinary Retention 11 8% Funiculitis 22 16% Table 6: Duration of Hernia in Relation to Type of Complication Type of Complication Duration of Hernia Number of Patients Percentage (%) Incarcerated hernia (n = 12) > 1 year 10 83% < 1 year 2 17% Obstructed hernia (n = 8) < 1 year 6 75% > 1 year 2 25% Strangulated hernia (n = 4) < 1 year 4 100% > 1 year 0 0% Figure 1: Age-Wise Distribution of Inguinal Hernia Patients (n = 200) Figure 2: Distribution of Postoperative Complications (n = 200) In this study of 247 inguinal hernia cases, the distribution across age groups showed that the majority of patients were between 40 and 60 years of age (122 cases, 49.4%), followed by those over 60 years (66 cases, 26.7%) and under 40 years (59 cases, 23.9%). Indirect inguinal hernia was the most common type overall, with 46 cases in patients under 40 years, 72 cases in the 40–60 years group, and 28 cases in those over 60 years. Direct hernias were more prevalent in older age groups, particularly in patients over 60 years (21 cases). Recurrent hernias were relatively rare but showed a slight increase with age, with 6 cases in the >60 years group. Bilateral hernias were also more frequent in older patients, with 8 cases in those over 60 years. Pantaloon hernias were predominantly observed in the 40–60 years age group (14 cases). Overall, the data indicate that indirect hernias are most common in younger patients, while direct and bilateral hernias tend to increase with age, with the peak incidence of hernias occurring in the 40–60 years age group. In this study of 200 patients, the majority were aged 40–60 years, accounting for 99 patients (49.5%). Patients under 40 years comprised 52 cases (26%), while those over 60 years accounted for 49 cases (24.5%). Overall, the highest proportion of patients was in the 40–60 years age group. In this study of 200 patients, indirect inguinal hernia was the most common type, occurring in 146 patients (68%), followed by direct hernia in 54 patients (27%) and recurrent hernia in 12 patients (6%). Right-sided hernias predominated, affecting 139 patients (69.5%) compared to 61 patients (30.5%) with left-sided hernias. Bilateral hernias were less common, seen in 16 patients (8%). Among the 4 female patients in the study, indirect inguinal hernia was the most common, occurring in 3 patients (75%), while direct hernia was seen in 1 patient (25%). All female patients (100%) had right-sided hernias, with no cases of left-sided hernia observed. In this study, the most common postoperative complications were sensory disturbance, seen in 27 cases (19.4%), followed by seroma in 25 cases (17.6%) and funiculitis in 22 cases (16%). Inguinodynia occurred in 14 patients (10%), urinary retention in 11 patients (8%), and hematoma in 13 patients (9%). Wound infection was observed in 9 cases (6.7%). Less frequent complications included orchitis in 3 cases (1.7%), recurrence in 2 cases (1.4%), and testicular atrophy, hydrocele, and entero-cutaneous fistula each in 1 case (0.7%). Among the 12 patients with incarcerated hernia, the majority (10 patients, 83%) had hernias for more than 1 year, while 2 patients (17%) had hernias for less than 1 year. Of the 8 patients with obstructed hernia, 6 patients (75%) had hernias for less than 1 year and 2 patients (25%) for more than 1 year. All 4 patients with strangulated hernia (100%) had hernias for less than 1 year, with none having hernias for more than 1 year.

The findings of the present study offer a comprehensive epidemiological and clinical profile of inguinal hernia, reinforcing and contrasting with well-established patterns in the global literature. The demographic distribution observed, with the peak incidence (49.4%) in the 40-60 years age group, aligns perfectly with the global burden of disease, which identifies inguinal hernia as most prevalent in the working-age male population, as supported by studies in [11] and [12]. This age represents a period where cumulative strain from physical activity and the onset of age-related tissue weakness converge. The predominance of indirect inguinal hernias, accounting for 68-73% of cases in our cohort, is a consistent finding worldwide and is fundamentally linked to patent processus vaginalis, a congenital predisposition [13]. However, the age-specific distribution of hernia types reveals a critical trend: while indirect hernias were most common in the younger demographic (<40 years), direct hernias demonstrated a clear increase in prevalence with advancing age, particularly in patients over 60. This shift underscores the etiological transition from a primarily congenital predisposition in the young to acquired weakness of the posterior wall of the inguinal canal (Hesselbach's triangle) in the elderly, a phenomenon extensively documented by [14] and [15]. Furthermore, the increased frequency of bilateral and recurrent hernias in older patients, as seen in our data, corroborates with studies like [16], which attribute this to generalized connective tissue frailty and the challenges of reoperative surgery.The strong predilection for right-sided hernias (69.5%) is another significant observation, consistent with the findings of [17]. This has been theorized to be due to the later descent of the right testis and the relative protection offered by the sigmoid colon on the left side. The exclusive presentation of right-sided hernias in our small female cohort, though limited in sample size, presents an intriguing area for further investigation and is noted in specialized series like [18]. Regarding complications, our postoperative profile, with sensory disturbance (19.4%) and seroma (17.6%) being most frequent, mirrors the outcomes reported in [19] for open mesh hernioplasty. The low recurrence rate of 1.4% is a testament to the efficacy of modern tension-free repair techniques and falls within the acceptable range reported by large registries such as [20]. Finally, the analysis of complicated hernias provides a crucial clinical insight: while incarcerated hernias were more common in patients with a long-standing history (>1 year), the more severe presentations of obstruction and, particularly, strangulation were overwhelmingly associated with a short duration of illness (<1 year). This critical finding suggests that the risk of catastrophic complications is not solely a function of chronicity but may be higher in the acute phase following hernia onset, a nuanced point that warrants emphasis in patient counseling and surgical timing decisions.

We conclude that, across these studies, inguinal hernias were most common in patients aged 40–60 years, with indirect hernias constituting the predominant type, especially in younger individuals. Direct, bilateral, and recurrent hernias showed an increasing trend with advancing age. Right-sided hernias were more frequent than left-sided, and females—though few in number—primarily presented with right-sided indirect hernias. Postoperative outcomes were generally favorable, with sensory disturbance, seroma, and funiculitis being the most common complications. More severe complications such as orchitis, recurrence, and testicular atrophy were rare. Hernia duration also influenced severity: incarcerated hernias were typically long-standing, while obstructed and strangulated hernias were more often associated with shorter durations. Overall, the findings reinforce the age-dependent distribution of hernia types and highlight the generally low rate of major postoperative complications.

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