Abdominal Wall Hernias in Patients with Hiatal Hernias: Predictors of Association in a Large Cohort of Patients

Abstract

Introduction: Hiatal hernia and abdominal wall hernia (AWH) have a common theme of pathogenesis and etiology. This suggests a potential relationship between these 2 types of hernia. However, no large studies have examined such an association. We designed the current study to characterize this association and identify factors associated with this coexistence. Methods: A database of patients seen at a large multi-center health network serving 3 states in the mid-Atlantic region of the United States was queried for patients with a documented diagnosis of hiatal hernia (HH) or paraesophageal hernia (PEH). This population was then divided into groups based on whether or not they had a history of another type of AWH (ventral, inguinal/ femoral, umbilical, or incisional hernia). Demographic and clinical data were compared between groups using univariate, followed by multivariable logistic analysis. Results: The final study population consisted of 28 114 patients (66.5% female) with HH/PEH. The prevalence of AWH in this population was 8.2% (n = 2299). Of these 69.1% had only one AWH with the remaining 30.9% having two or more hernias. Multivariable analysis showed male patients with HH/PEH were more likely to have AWH (OR: 1.97; 95% CI: 1.810-2.162, P <0.0001). The odds of AWH were higher in patients aged 50 to 80 years old compared to younger patients (OR: 1.527; 95% CI: 1.348-1.730, P <0.0001). Patients with any comorbidity were also more likely to develop AWH (OR: 1.764; 95% CI: 1.566-1.986, P < 0.0001), with obstructive sleep apnea (OSA) being the comorbidity with the highest risk (OR: 1.295; 95% CI: 1.161-1.444, P <0.0001), followed by obesity (OR: 1.267; 95% CI: 1.156-1.388, P <0.0001). Conclusion: The prevalence of an AWH in patients with a HH/PEH was 8.2%. Although HH/PEH are more prevalent in females, males with HH/PEH are at higher risk for AWH. Obesity, OSA, tobacco use, hypertension, diabetes, and hypothyroidism are independent risk factors for presence of an AWH in patients with HH/PEH.