P1192 - Is Inguinal Hernia Associated With an Increased Risk of Colon Cancer? A Systematic Review and Meta-Analysis

Monday, October 25, 2021

10:30 AM – 4:15 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Shreya Narayanan, MD

University of South Florida Morsani College of Medicine
Tampa, FL, United States

Shreya Narayanan, MD¹, Ambuj Kumar, MD¹, Tea Reljic, MPH², Wojciech Blonski, MD, PhD¹
¹University of South Florida Morsani College of Medicine, Tampa, FL; ²University of South Florida, Tampa, FL

Introduction: The presence of an inguinal hernia has been anecdotally associated with an increased risk of identifying colon cancer, and therefore colonoscopy is recommended prior to inguinal hernia repair. However, the evidence on the association between the presence of an inguinal hernia and colon cancer is conflicting and uncertain. We performed a systematic review and meta-analysis to synthesize all available evidence on this topic.

Methods: A comprehensive search of PubMed and EMBASE was performed. Any comparative study (case-control or cohort study) comparing the rate of colon cancer detection in patients with and without inguinal hernias who underwent screening colonoscopy or flexible sigmoidoscopy was eligible for inclusion. Data were extracted and pooled under a random effects model.

Results: The initial search identified 692 references, of which 4 comparative studies (1462 patients) met the inclusion criteria (Table 1). The overall risk of bias in the included studies was low. Pooled results showed a statistically non-significant difference in the incidence of detection of colon cancer, with patients with inguinal hernia having a 1.26 times increased likelihood of colon cancer diagnosis compared with patients without inguinal hernia (odds ratio (OR) 1.26; 95% confidence interval (CI) 0.63-2.51; P = 0.51) (Figure 1A). Although patients with inguinal hernia were also 1.23 times more likely to be diagnosed with colon polyps compared to patients without inguinal hernia, this difference was statistically non-significant (OR 1.23; 95% CI 0.94-1.60; P = 0.12) (Figure 1B).

Discussion: The findings from this first systematic review and meta-analysis show that there is no difference in the incidence of either colon cancer or colon polyps in patients with inguinal hernias compared to those without. Nevertheless, future prospective randomized control studies are needed to further investigate the relationship between the risk of colon cancer or polyps and the presence of inguinal hernia.

Figure: Figure 1A Incidence of Colon Cancer, Figure 1B Incidence of Colon Polyps

Study	Location and Years of Enrollment	Study Type	Total Number of Patients Enrolled	Mean Age (Case)	Mean Age (Control)	Type of Endoscopy
Avidan 2002	VA Hospital - Hines, IL 1/1990-12/1992	Case-control	200	62 ± 12	66 ± 10	Flexible sigmoidoscopy, with reflex to full colonoscopy if lesion detected
Avidan 2004	Sheba Medical Center - Tel Aviv, Israel 1/1996-12/1997	Case-control	777	44 ± 3 70 ± 9	44 ± 3 64 ± 7	Colonoscopy
Gerson 2001	VA Palo Alto Healthcare System - Palo Alto, CA 1990-2000	Case-control	298	67 ± 0.7	66 ± 0.8	Flexible sigmoidoscopy, with reflex to full colonoscopy if lesion detected
Wheeler 1991	Huntington Veteran Affairs Medical Center - Huntington, WV 6/1986-12/1989	Case-control	187	59.7	65.6	Flexible sigmoidoscopy, with reflex to full colonoscopy if lesion detected

Table: Characteristics of Included Studies

Disclosures:

Shreya Narayanan indicated no relevant financial relationships.

Ambuj Kumar indicated no relevant financial relationships.

Tea Reljic indicated no relevant financial relationships.

Wojciech Blonski indicated no relevant financial relationships.

Shreya Narayanan, MD¹, Ambuj Kumar, MD¹, Tea Reljic, MPH², Wojciech Blonski, MD, PhD¹. P1192 - Is Inguinal Hernia Associated With an Increased Risk of Colon Cancer? A Systematic Review and Meta-Analysis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.