Work-relatedness of inguinal hernia: a systematic review including meta-analysis and GRADE

Hernia. 2020 Oct;24(5):943-950. doi: 10.1007/s10029-020-02236-0. Epub 2020 May 30.


Purpose: Clinicians need to know whether inguinal hernia (IH) can be attributed to work to answer questions regarding prevention and medical causation. This review describes whether work-related risk factors are associated with IH.

Methods: A systematic review was performed in Medline via PubMed until February 3rd, 2020. Inclusion criteria were that IH was diagnosed by a clinician, and workers exposed to work-related risk factors were compared to workers less exposed or not at all. A quality assessment and a meta-analysis using Cochrane's RevMan 5.3 were performed, including GRADE for quality of evidence.

Results: The search resulted in 540 references. Fourteen studies fulfilled the inclusion criteria, of which three were included in a meta-analysis, all three being of high quality, including 621 workers diagnosed with IH. The meta-analysis revealed significant associations with physically demanding work (OR 2.30, 95% CI 1.56-3.40). Two prospective studies, including 382 and 22,926 cases revealed associations that this was true for male workers with a lateral IH that reported standing or walking for more than six hours per workday (OR 1.45, 95% CI 1.12-1.88) or lifting cumulative loads of more than 4000 kg per workday (OR 1.32, 95% CI 1.27-1.38). The level of certainty for the latter two work-related risk factors was moderate and high according to GRADE.

Conclusion: Lateral IH among males is associated with work-related risk factors depending on the level of exposure to the time standing/walking per workday, or the amount of load lifted per workday.

Keywords: Etiology; Occupational disease; Occupational exposure; Prevention; Risk factors.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Female
  • Hernia, Inguinal / diagnosis
  • Hernia, Inguinal / epidemiology*
  • Hernia, Inguinal / surgery
  • Herniorrhaphy
  • Humans
  • Male
  • Occupational Diseases / diagnosis
  • Occupational Diseases / epidemiology*
  • Occupational Diseases / surgery
  • Risk Factors
  • Sex Factors