Inguinal hernia is one of the most common surgical conditions encountered worldwide and represents a significant public health burden. Globally, an estimated 20 million inguinal hernia repairs are performed each year, making it one of the most frequently undertaken general surgical procedures.1 Inguinal hernias result from a weakness in the abdominal wall musculature, allowing abdominal contents to protrude through the inguinal canal, and are predominantly seen in males. The development of inguinal hernia is multifactorial, involving both congenital and acquired factors. Established risk factors include male gender, increasing age, family history, chronic cough, constipation, smoking, heavy manual labour, obesity, and conditions associated with increased intra-abdominal pressure.2,3 Alterations in connective tissue metabolism and abnormal collagen composition have also been implicated, contributing to reduced tensile strength of the abdominal wall and hernia formation.4 In the Indian context, inguinal hernia constitutes a major proportion of general surgical outpatient visits and hospital admissions. Studies from India report a higher prevalence of inguinal hernia among individuals engaged in heavy physical work and in populations with limited access to preventive healthcare services.5 Delayed presentation is common due to lack of awareness, socioeconomic constraints, and limited healthcare access, especially in rural and semi-urban regions. Consequently, a significant number of patients present with complications such as incarceration or strangulation. Complicated inguinal hernias are associated with increased morbidity, longer hospital stay, and higher postoperative complication rates compared to elective repairs. Emergency hernia surgeries, particularly in elderly patients, carry a substantially higher risk of adverse outcomes.6 Early identification of risk factors and timely surgical intervention are therefore essential to reduce morbidity and mortality. Surgical repair remains the definitive treatment for inguinal hernia, with techniques evolving from conventional tissue repairs to tension-free mesh-based repairs. Both open and laparoscopic approaches are practiced globally and in India, with the choice of procedure influenced by patient factors, surgeon expertise, and available resources. Despite advances in surgical techniques and standardized guidelines, recurrence, postoperative complications, and chronic groin pain remain important concerns affecting long-term patient outcomes.7 A comprehensive understanding of the clinical profile, identification of associated risk factors, and evaluation of surgical outcomes are crucial for improving patient care and optimizing surgical strategies. Prospective observational studies provide valuable real-world data and help identify predictors of adverse outcomes. The present study was therefore undertaken to evaluate the clinical profile, risk factors, and surgical outcomes in patients with inguinal hernia in an Indian tertiary care setting. AIM To evaluate the clinical profile, associated risk factors, and surgical outcomes in patients with inguinal hernia. OBJECTIVES 1. To study the demographic and clinical characteristics of patients presenting with inguinal hernia.

Study Design and Setting This was a prospective observational study conducted in the Department of General Surgery at a tertiary care teaching hospital in India. Written informed consent was obtained from all participants prior to inclusion in the study. Study Population All patients presenting with a diagnosis of inguinal hernia and planned for elective or emergency surgical repair during the study period were considered for inclusion. Sample Size A total of 150 patients with inguinal hernia were included in the study. The sample size was determined based on previous institutional records and published literature, assuming a confidence level of 95% and a power of 80%, and was considered adequate to evaluate clinical profile, risk factors, and surgical outcomes. Inclusion Criteria • Patients aged ≥18 years • Patients diagnosed with unilateral or bilateral inguinal hernia • Patients undergoing open or laparoscopic inguinal hernia repair • Patients willing to provide informed consent Exclusion Criteria • Patients with recurrent inguinal hernia • Patients with femoral or other types of hernia • Patients with severe comorbid illness precluding surgery • Patients unwilling to participate in the study Data Collection and Preoperative Assessment Detailed clinical history was obtained from all patients, including age, sex, occupation, duration of symptoms, and presence of risk factors such as chronic cough, constipation, smoking, heavy physical activity, and comorbid conditions. A thorough physical examination was performed to determine the type and side of hernia. Routine preoperative investigations were carried out for all patients as per institutional protocol. Surgical Procedure Patients underwent open or laparoscopic inguinal hernia repair based on surgeon preference and patient suitability. Open repair included Lichtenstein tension-free mesh repair, while laparoscopic repair was performed using TAPP or TEP techniques. Details regarding type of anaesthesia, operative time, and intraoperative findings were recorded. Postoperative Assessment and Outcomes Patients were monitored postoperatively for complications such as surgical site infection, seroma, hematoma, urinary retention, and chronic groin pain. Duration of hospital stay and time to return to normal activity were documented. Follow-up Patients were followed up at 1 week, 1 month, and 3 months postoperatively to assess wound healing, complications, and recurrence. Statistical Analysis Data were entered into Microsoft Excel and analysed using SPSS. Continuous variables were expressed as mean ± standard deviation, while categorical variables were expressed as frequency and percentage. Associations between risk factors and outcomes were analysed using the Chi-square test or Fisher’s exact test. A p-value <0.05 was considered statistically significant.

A total of 150 patients diagnosed with inguinal hernia were prospectively evaluated. Table 1. Demographic Characteristics of Patients (Clinical Profile) Variable Number (%) Mean age (years) ± SD 46.8 ± 13.2 Male 138 (92.0) Female 12 (8.0) Male: Female ratio 11.5: 1 Interpretation: The present study demonstrates a marked male predominance (92%) in patients with inguinal hernia, with a male-to-female ratio of 11.5:1. This strong gender disparity can be attributed to anatomical differences such as a wider inguinal canal in males, presence of the spermatic cord, and greater exposure to occupational strain. Table 2. Age-wise Distribution of Patients Age group (years) Number (%) 18–30 24 (16.0) 31–45 44 (29.3) 46–60 52 (34.7) >60 30 (20.0) Interpretation: The peak incidence in the 46–60-year age group (34.7%) indicates that inguinal hernia is most common during middle age, when cumulative weakening of the abdominal musculature combines with long-standing exposure to risk factors such as heavy physical activity, smoking, and chronic cough. The notable proportion of elderly patients (>60 years) further highlights the degenerative component in hernia formation. Table 3. Hernia Characteristics at Presentation Parameter Number (%) Right-sided 84 (56.0) Left-sided 52 (34.7) Bilateral 14 (9.3) Indirect hernia 96 (64.0) Direct hernia 44 (29.3) Pantaloon hernia 10 (6.7) Interpretation: Right-sided inguinal hernia (56%) was more common than left-sided hernia, which may be explained by delayed descent of the right testis and later closure of the right processus vaginalis. Indirect inguinal hernia (64%) was the predominant type observed. This finding supports the concept that congenital weakness at the deep inguinal ring plays a major role, even in adults, and becomes clinically evident when compounded by increased intra-abdominal pressure. The presence of pantaloon hernia, though less common, reflects advanced disease involving both direct and indirect components. Table 4. Distribution of Risk Factors Among Patients Risk factor Present n (%) Heavy manual labour 64 (42.7) Smoking 58 (38.7) Chronic cough 42 (28.0) Constipation 36 (24.0) Prostatism 22 (14.7) Interpretation: Heavy manual labor (42.7%) emerged as the most prevalent risk factor, followed by smoking (38.7%) and chronic cough (28%). These factors are known to cause repeated elevation of intra-abdominal pressure, leading to gradual weakening of the inguinal floor. Constipation and prostatism, though less frequent, are important contributors, particularly in elderly patients, due to chronic straining during defecation and micturition. Table 5. Association Between Risk Factors and Type of Hernia Risk factor Indirect n (%) Direct n (%) p-value Smoking 40 (69.0) 18 (31.0) 0.04 Heavy labour 46 (71.9) 18 (28.1) 0.03 Interpretation: A statistically significant association was observed between smoking and indirect inguinal hernia (p=0.04), as well as heavy manual labour and indirect hernia (p=0.03). This suggests that lifestyle and occupational factors may exacerbate pre-existing congenital weaknesses rather than directly causing acquired defects. Table 6. Surgical Procedure Performed Procedure Number (%) Open Lichtenstein mesh repair 118 (78.7) Laparoscopic repair (TAPP/TEP) 32 (21.3) Interpretation: Open Lichtenstein mesh repair was performed in 78.7% of cases, making it the most commonly employed surgical technique. This reflects its proven efficacy, low recurrence rate, and cost-effectiveness, especially in resource-limited settings such as developing countries. Laparoscopic repair (21.3%) was selectively used in suitable patients, indicating gradual adoption of minimally invasive techniques. Table 7. Operative and Postoperative Outcomes Outcome parameter Mean ± SD / n (%) Mean operative time (minutes) 58.4 ± 12.6 Hospital stay ≤3 days 104 (69.3) Hospital stay >3 days 46 (30.7) Interpretation: The mean operative time of 58.4 ± 12.6 minutes indicates procedural efficiency and surgeon familiarity with mesh repair techniques. A large proportion of patients (69.3%) were discharged within three days, demonstrating favourable early postoperative recovery and reduced hospital burden. Table 8. Postoperative Complications Complication Number (%) No complications 126 (84.0) Surgical site infection 12 (8.0) Seroma 6 (4.0) Hematoma 4 (2.7) Chronic groin pain 2 (1.3) Interpretation: The overall postoperative complication rate was low (16%). Surgical site infection (8%) was the most common complication, followed by seroma and hematoma. Chronic groin pain was rare (1.3%), reflecting appropriate surgical technique and nerve preservation. The high proportion of patients without complications (84%) underscores the safety and effectiveness of modern inguinal hernia repair. Table 9. Association Between Risk Factors and Postoperative Complications Risk factor Complications Present n (%) p-value Smoking 14 (24.1) 0.02 Heavy manual labour 16 (25.0) 0.03 Chronic cough 12 (28.6) 0.01 Interpretation: Smoking, heavy manual labour, and chronic cough showed a statistically significant association with postoperative complications. These findings suggest impaired wound healing, increased postoperative strain, and poor tissue quality in patients with these risk factors.

In the present prospective study of 150 patients with inguinal hernia, the clinical profile, risk factors, and surgical outcomes were systematically evaluated. Our study demonstrated a marked male predominance (92%, n=138) (Table 1), with a male-to-female ratio of 11.5:1. This is consistent with previous reports showing higher prevalence in males due to anatomical differences such as a wider inguinal canal, presence of the spermatic cord, and occupational exposure.8,9 The most affected age group was 46–60 years (34.7%), which aligns with findings in both Indian and international studies, reflecting the cumulative effect of age-related weakening of the abdominal wall and prolonged exposure to risk factors.10 Regarding hernia characteristics, the right-sided hernia predominated (56%), and indirect hernia was the most common type (64%) (Table 3). These findings are consistent with the natural history of hernia formation due to delayed obliteration of the right processus vaginalis and congenital predisposition11. Bilateral and pantaloon hernias were less common (9.3% and 6.7%, respectively), in line with global prevalence data. Analysis of risk factors revealed that heavy manual labor (42.7%) and smoking (38.7%) were the most prevalent (Table 4), followed by chronic cough (28%) and constipation (24%). These factors increase intra-abdominal pressure and contribute to weakening of the abdominal wall, which is well documented in literature.12 Table 5 shows a statistically significant association between smoking and indirect hernia (p=0.04), as well as heavy labor and indirect hernia (p=0.03), suggesting these factors accelerate the manifestation of pre-existing anatomical weakness.13 These results highlight the importance of lifestyle and occupational interventions in hernia prevention. In our cohort, open Lichtenstein mesh repair was performed in 118 patients (78.7%), while laparoscopic repair (TAPP/TEP) was performed in 32 patients (21.3%) (Table 6). Open mesh repair remains the most widely practiced technique in resource-limited settings due to its ease, cost-effectiveness, and low recurrence rate, while laparoscopic techniques are selectively used in suitable candidates.14 Postoperative recovery was favourable in most patients. Hospital stay ≤3 days was observed in 104 patients (69.3%), and only 46 patients (30.7%) required longer admission (Table 7). Postoperative complications occurred in 24 patients (16%), with surgical site infection being the most common (8%) (Table 8). The low incidence of chronic groin pain (1.3%) and hematoma (2.7%) indicate safe and effective surgical practice. These results are comparable with outcomes reported in the European Hernia Society guidelines and other large series.15 Importantly, smoking, heavy manual labor, and chronic cough were significantly associated with postoperative complications (p=0.02, 0.03, and 0.01, respectively) (Table 9). This emphasizes that modifiable patient-related risk factors play a key role in postoperative morbidity and should be addressed preoperatively to optimize outcomes.16 The study demonstrates that inguinal hernia predominantly affects middle-aged males, is most commonly indirect and right-sided, and that heavy labour and smoking are significant risk factors. Open mesh repair yields excellent outcomes with low complication rates, though patients with high-risk profiles require careful perioperative monitoring. The findings have important implications for clinical practice in India, where delayed presentation and occupational exposures increase the risk of complicated hernia and postoperative morbidity. Identification of high-risk patients using clinical and lifestyle parameters can improve surgical planning and postoperative care.

Preoperative assessment of patients with inguinal hernia reveals that middle-aged males are predominantly affected, with indirect and right-sided hernias being the most common. Heavy manual labor and smoking are significant risk factors. Open mesh repair is safe and effective, yielding low postoperative complications. Identification of high-risk patients can help optimize perioperative care and improve surgical outcomes.

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