Surgery for inguinal hernias is among the most common procedures in Sweden. Erik Axman鈥檚 doctoral thesis evaluates the outcomes of different surgical techniques. Furthermore, he emphasizes the necessity for a dedicated inguinal hernia registry for children to enhance pediatric hernia surgery.
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Erik Axman, a researcher at the Institute of Clinical 91探花s and a resident physician at the Pediatric Surgery Unit, Queen Silvia Children鈥檚 Hospital.
Approximately one-third of men and one-twentieth of women experience inguinal hernias during their lifetime. It鈥檚 caused by a weakening in the abdominal wall where both peritoneum and abdominal contents can be pressed out at the groin. It appears as a bulge on the skin and can cause discomfort and pain.
What is the focus of your thesis? 鈥淢y research revolves around utilizing data from the Swedish Hernia Registry to examine the outcomes of inguinal hernia surgeries, combining information from other registries and patient-related outcome measures. The evaluation in this thesis primarily focuses on the risks of hernia recurrence and prolonged post-operative pain,鈥 says Erik Axman, who conducts research at the Institute of Clinical 91探花s and works as a general surgery specialist and resident physician at the Pediatric Surgery Unit, Queen Silvia Children鈥檚 Hospital.
Cover image of the thesis. Illustration from the late 19th century, showing the anatomy of the anterior abdominal wall, by Henry Orlando Macy (1837-1924).
鈥Better outcomes in women鈥
What are the key findings of your research? 鈥淭he Swedish Hernia Registry includes over 90% of surgeries in Sweden, and the registry鈥檚 data aligns with patient records. Employing self-adhesive mesh in surgery doesn鈥檛 reduce pain risk but doesn鈥檛 increase the likelihood of hernia recurrence either, accompanied by shorter operation durations. Inguinal hernias don鈥檛 correlate with heightened risk of anastomotic leak in colorectal cancer surgery.鈥
Erik Axman鈥檚 registry studies demonstrate that the outcomes of surgeries have improved over time.
鈥淥ver the past 30 years, the risk of needing surgery for a recurrence of inguinal hernia has significantly decreased. Women have transitioned from having poorer outcomes to having better results than men regarding the risk of needing a new operation. Laparoscopic surgeries for women are associated with the best results.鈥
Figure 4, page 22 in the thesis. Proportion of reoperations due to recurrence from 1992 to 2022 in the Swedish Hernia Register. Yellow: Total. Black: Males. Blue: Females.
Lack of registries for children
What challenges have you encountered in your doctoral project? 鈥淚鈥檝e worked in a small research group with colleagues spread across Sweden, which has been enjoyable but also comes with its challenges. Combining research with clinical work can be intense at times but also rewarding,鈥 says Erik Axman, and continues:
鈥淎s a surgeon, I鈥檝e transitioned from treating adult patients to now treating children. One realization is that there鈥檚 a lack of inguinal hernia registry for children worldwide and in Sweden. Such a registry has the potential to enhance the quality of inguinal hernia surgery for children in Sweden.鈥