Abstract BACKGROUND: Occupational exposures involving heavy manual lifting, prolonged standing, and physically demanding labor represent established risk factors for abdominal wall hernia development. Saudi Arabia’s labor force, characterized by a substantial manual workforce concentrated in construction, manufacturing, and agriculture, may carry elevated occupational hernia risk, yet population-level analyses quantifying these associations are absent from the literature. OBJECTIVES: This study aims to characterize the prevalence of self-reported abdominal wall hernias by occupational category among Saudi working-age adults, quantify the association between specific occupational exposures and hernia risk, and assess geographic and demographic variations in occupationally attributed hernia burden. METHODS: This cross-sectional descriptive study analyzed secondary data from the Saudi Health Interview Survey 2018 ( n = 10,735 adults aged 18–65 years), Saudi General Authority for Statistics Labor Force Survey 2018–2023, and Saudi Ministry of Health Annual Statistical Yearbooks. Hernia prevalence was stratified by occupational category using the International Standard Classification of Occupations. The specific exposures analyzed included heavy manual lifting, prolonged standing, and physically demanding labor. Comparative analyses and prevalence ratios (PRs) were calculated. Reporting followed strengthening the reporting of observational studies in epidemiology guidelines. RESULTS: The overall self-reported hernia prevalence was 8.3% among working-age adults. Manual laborers demonstrated the highest hernia prevalence (14.7%), followed by construction and extraction workers (13.2%) and agricultural workers (11.8%), compared to 4.1% among professional/managerial workers. Hernia prevalence was significantly associated with daily heavy lifting exceeding 20 kg (PR: 2.84; 95% confidence interval [CI]: 2.31–3.49), prolonged standing exceeding 6 h per day (PR: 1.76; 95% CI: 1.42–2.18), and duration of occupational exposure exceeding 10 years (PR: 2.21; 95% CI: 1.87–2.61). Male sex, age 45–65 years, and concurrent obesity amplified occupational hernia risk. Geographic analysis revealed highest hernia procedure rates in regions with concentrated industrial and agricultural workforces. CONCLUSIONS: Occupational exposures, particularly heavy manual lifting and prolonged standing, are significantly associated with abdominal wall hernia prevalence in Saudi Arabia’s working-age population. Targeted workplace prevention programs, ergonomic interventions, pre-employment screening, and enhanced access to hernia repair services for manual labor sectors represent priority occupational health policy actions.
BACKGROUND: Loss of domain (LOD) in complex ventral hernia (CVH) poses a major surgical challenge due to volumetric imbalance between the hernia sac and abdominal cavity, risking intra-abdominal hypertension and abdominal compartment syndrome. Management strategies remain heterogeneous. MATERIALS AND METHODS: This narrative review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews framework. A systematic search of PubMed, Embase, and Scopus identified studies published up to January 2026 using terms including “loss of domain,” “complex ventral hernia,” “Tanaka index,”“Sabbagh ratio,” “CT volumetry,” “botulinum toxin,”“progressive pneumoperitoneum,” “component separation,” “Fasciotens,” and “robotic abdominal wall reconstruction.” Two authors independently screened the titles and abstracts. The included studies comprised consensus statements, systematic reviews, meta-analyses, and cohort studies with ≥ 20 patients. Case reports, editorials, and non-English studies were excluded. Findings were synthesized descriptively. RESULTS: Computed tomography volumetry is the diagnostic gold standard for quantifying LOD. A Tanaka index > 25% and Sabbagh ratio > 20% identify patients at high risk for tensioned closure. Prehabilitation—including smoking cessation, glycemic control, and weight optimization—reduces surgical site morbidity. Botulinum toxin A (BTA) increases lateral abdominal wall compliance by approximately 4 cm per side, while progressive preoperative pneumoperitoneum (PPP) expands the abdominal cavity volume by up to 53%. Combined BTA and PPP achieve high primary fascial closure rates in massive defects. Transversus abdominis release provides durable retromuscular reconstruction with lower recurrence than anterior component separation. Emerging adjuncts such as Fasciotens and prolonged CO2 insufflation offer additional muscle lengthening of up to 25%. CONCLUSION: CVH with LOD requires objective volumetric assessment and a tailored, algorithm-based approach integrating prehabilitation, domain-expanding techniques, and neurovascular-preserving reconstruction to improve the outcomes and reduce recurrence.
Primary scrotal lipomas of giant proportions are exceptionally rare and frequently present as an irreducible inguinoscrotal hernia leading to misdiagnosis. These lesions are often identified incidentally during surgical exploration, as in our case, posing a diagnostic dilemma. Diagnostic ambiguity associated with these swellings often results in inadequate preoperative evaluation, thereby presenting unforeseen challenges during surgery. Although scrotal exploration remains the definitive treatment, comprehensive preoperative assessment is crucial to avoid intraoperative surprises and to help the clinician provide better surgical planning and outcomes. Here, we report a case of a giant primary scrotal lipoma arising from the spermatic cord in a 47-year-old male, presenting as a painless, progressively enlarging, nontransilluminant scrotal swelling. The lesion was initially misdiagnosed as an irreducible inguinoscrotal hernia on ultrasound, highlighting the importance of adequate preoperative evaluation. In addition, we would like to emphasize the consideration of such a rare entity as the differential diagnosis of giant scrotal swellings.
Laparoscopic inguinal hernia repair is increasingly performed because of reduced postoperative pain and faster recovery compared with open surgery. However, carbon dioxide (CO2) insufflation may lead to specific complications, including subcutaneous emphysema (SE). A 65-year-old man underwent elective totally extraperitoneal extended view repair for right inguinal hernia. Fifty minutes after CO2 insufflation, a progressive rise in end-tidal CO2 reaching 60 mmHg was observed, accompanied by mild oxygen desaturation. Physical examination revealed subcutaneous crepitus extending to the patient’s neck. Ventilatory adjustments were performed, and the insufflation pressure was reduced. Subcutaneous catheters were inserted into the supraclavicular region. The procedure was successfully completed. Postoperative chest radiography confirmed extensive SE without pneumothorax or pneumomediastinum. The patient remained clinically stable and was conservatively managed. Complete resolution was confirmed radiologically, and the patient was discharged on the third postoperative day. SE is an uncommon but increasingly recognized complication of extraperitoneal laparoscopic hernia repair. Vigilant intraoperative monitoring allows for early detection and appropriate management, preventing unnecessary morbidity.
Lumbar and flank hernias are rare, and the ideal repair approach remains debated. There have been fewer than 1500 lumbar/flank hernias reported in the literature, and cases due to traumatic injury are even rarer. In this case report, we describe a traumatic flank hernia in a patient who was pinned between two motor vehicles, an accident that resulted in avulsion of the oblique muscles from the iliac crest. Additional traumatic injuries included bucket-handle injuries of the ileum requiring small bowel resection, and multiple orthopedic injuries. After initial small bowel resection and resuscitation, subsequent imaging demonstrated the new anastomosis herniating into an 11 cm × 6 cm flank hernia with avulsion of the oblique muscles. The hernia was repaired primarily with iliac crest bone anchors and no mesh placement. Recovery was uncomplicated, and the patient was discharged to an acute rehabilitation unit. At 12 months post-repair, there is no recurrence.
