1. Introduction and Background
Hernia surgery is among the most common surgical procedures, the majority performed as elective operations. However, the proportion of emergency procedures is considerable, and these are associated with significantly higher morbidity and mortality compared with elective surgery.
In Finland, approximately 500 emergency groin hernia repairs and 600 ventral hernia repairs are performed annually. Current treatment practices for emergency hernia surgery vary substantially, and scientific evidence on management and outcomes is lacking. Existing guidelines are partly outdated and largely based on expert opinion.
The aim of this study is to provide new, scientifically robust evidence on the outcomes, complications, and postoperative quality of life following emergency hernia surgery.
2. Study Objectives
The primary objective is to assess the short- and long-term outcomes of different surgical techniques in emergency groin and ventral hernia repairs. Specifically, the study will evaluate:
Surgical outcomes and complications within 30 and 90 days postoperatively
Risk of recurrence and quality of life at 1, 2, and 5 years
Impact of wound and mesh infections, as well as other postoperative factors, on recurrence
Effectiveness and safety of different surgical techniques
The results will support more evidence-based and precise recommendations on surgical methods, urgency classification, and the role of surgeon expertise.
3. Study Design and Patient Cohort
This is a multicenter study with a prospective patient cohort of emergency groin and ventral hernia repairs. Patients will be recruited over two years and followed up for five years postoperatively. The aim is to include as many eligible patients as possible.
Inclusion criterion
Emergency repair of a groin or ventral hernia
Exclusion criteria
Pregnancy
Age under 18 years
Advanced malignancy
Inability to follow up (e.g., long travel distance or poor functional status)
Participation in another study
Lack of informed consent
Estimated sample size: \~600 patients recruited across participating Finnish hospitals.
4. Methods and Data Collection
Data will be collected in the REDCap system at the following time points:
Baseline (preoperative): Patient demographics (age, sex, BMI) and comorbidities
Intraoperative: Surgical technique, procedures performed, duration of surgery
Postoperative (hospital stay): Recovery, complications, reoperations
Follow-up at 30 days, 90 days, 1, 2, and 5 years:
Recurrence (clinically and with imaging if needed)
Quality of life (RAND-36, AAS, PROMIS)
Complications, readmissions, recovery time, sick leave
Patients will be contacted by phone at each follow-up. If recovery is delayed, complications are suspected, or recurrence is possible, patients will be invited for further assessment at the hospital where the surgery was performed.
5. Statistical Analysis
The primary endpoint is hernia recurrence within two years after surgery.
Statistical methods include:
Kaplan-Meier analysis for comparison of surgical techniques
Chi-square test and Fisher's exact test for categorical variables
Student's t-test for continuous variables
Multivariate analysis for independent risk factors
Analyses will be conducted using IBM SPSS Statistics. A p-value \< 0.05 will be considered statistically significant.
6. Ethical Considerations and Data Protection
The study has been approved by the Ethics Committee of the Wellbeing Services County of North Ostrobothnia. Local research permits will be obtained from each participating hospital before study initiation.
Participation is voluntary, and written informed consent will be obtained from all patients. Clinical management will follow local treatment protocols regardless of study participation. Patient data will be stored in a pseudonymized form. The data controller is the Wellbeing Services County of North Ostrobothnia.
7. Timeline
2024-2026: Patient recruitment and initiation of follow-up. Study start date: 1 September 2025 across all participating hospitals.
2028: Data analysis and first publication on the primary endpoint
2031: Completion of follow-up and publication of long-term outcomes
