A retrospective cohort study of open preperitoneal repair versus open suture repair for the treatment of emergency femoral hernia

Abstract

to compare the outcomes of open preperitoneal repair (opR) with the use of mesh and open suture repair (oSR) without mesh via inguinal approach for the treatment of emergency femoral hernia (fH). the primary outcome was the postoperative complication and the secondary outcomes were the recurrence rate of FH and the postoperative comfort level at the surgical site. 104 patients with emergency FHs were included, of whom 51 patients were treated with OPR, 53 patients were treated with OSR. Between the two groups, no significant difference was found in surgical site infection (SSI) (p = 0.801) or seroma (P = 0.843), while there was significant difference in the improvement of comfort at the surgical site (p = 0.013). The results of the 2-year follow-up demonstrated 1 and 8 cases of recurrence in the OPR and OSR group respectively, which was statistically significant (HR, 8.193 [95% CI, 1.024 to 65.547], P = 0.047). Compared with OSR, OPR with the use of mesh did not increase the risk of SSi and was safe to apply even under the condition of an emergency fH operation with intestine resection; opR could reduce the recurrence rate of fH and improve the comfort at the surgical site.The incidence of femoral hernia is not high, accounting for approximately 2-4% of all groin hernias 1,2 , but it is extremely easy for femoral hernias (FHs) to incarcerate and/or strangulate 3,4 , and patients need emergency surgery after incarceration and/or strangulation 5,6 . The surgical methods include tissue suture repair and tension-free repair with different kinds of meshes. Clinical guidelines do not strongly recommend tension-free repair with mesh because this approach may cause surgical site infection (SSI), especially in patients who undergo intestinal resection 7,8 . At present, with the improvement of mesh materials, there have been continuous reports of the safe use of mesh in the repair of incarcerated and/or strangulated groin hernias or even in the condition of intestinal resection without the occurrence of serious complications such as mesh-related infection 9-11 .However, cohort studies comparing open mesh tension-free repair and open suture repair for emergency femoral hernias via the inguinal approach have rarely been reported. The purpose of this study was to evaluate the feasibility of open preperitoneal repair (OPR) for emergency FHs using UHS meshes by comparing the outcomes with those of open suture repair (OSR) for the treatment of emergency FHs. patients and Methods ethics statement. This retrospective cohort study was approved by the Medical Ethics Committee of Ganzhou People's Hospital, and the methods were carried out in accordance with the approved guidelines.patients. By referencing the medical records, consecutive patients with a primary diagnosis of FH treated between 2011 and 2017 were identified. Patients who underwent emergency FH repair via OPR with the use of UHS mesh or OSR without the use of mesh were selected and divided into two groups (the OPR group and OSR group) according to the repair method.