Is a Technically Challenging Procedure More Likely to Fail? A Prospective Single-Center Study on the Short- and Long-Term Outcomes of Inguinal Hernia Repair

Abstract

Background and Aims The aim of this prospective single-center study was to evaluate the outcome of inguinal hernia repair. Materials and Methods A total of 485 inguinal hernias (452 patients and 33 patients with bilateral hernias) were operated between January 2004 and December 2010. Mean age was 56 years, and 93% were male. Patient demographics and operative data were collected, and the operating surgeon assessed the technical difficulty of the operation. Five years after surgery, a questionnaire evaluated recurrence and chronic discomfort according to the Cunningham scale. 372 responded (82%), and mean follow-up was 5.5 years. Results There were 390 repairs for a primary and 62 for a recurrent hernia. Totally extraperitoneal (TEP) operation was most frequently performed (56%), transabdominal preperitoneal (TAPP) operation in 31%, and Lichtenstein and Shouldice in 12% and 2%, respectively. At 5-year follow-up, the primary outcome of chronic discomfort was 19.5%. The independent positive predictors were young age and operation for a recurrent hernia (OR: 3.7), with TEP operation reducing the risk of chronic discomfort (OR: 0.5). The secondary outcome was the recurrence rate of 2.5%. Risk factors were strenuous work (OR: 13.7), technically difficult repairs (OR: 7.2), and chronic discomfort (OR: 6.7). Conclusions Every fifth patient had chronic discomfort in long-term follow-up. The recurrence rate was 2.5%, and a technically difficult procedure was a risk factor.

Factors Associated with Postoperative Chronic Pain and Recurrence After Laparoscopic Total Extraperitoneal Inguinal Hernia Repair

“…There are few studies assessing the predictors of pain after TEP repair. Onlay mesh placement, fixation of the mesh, strenuous physical activity, young age, and poor general health have been suggested to increase postoperative chronic pain incidence (11)(12)(13)(14). In our study, we found higher pain incidence with higher BMI, using microporous mesh, mesh fixation, fixation with titanium tacks, and at the beginning of the learning curve.…”

“…Similarly, postoperative chronic pain was 14% and 7.2% before and after the 50 th case (p=0.043). In a recent study, Berndsen et al (14) reported a 2.5% recurrence after 485 laparoscopic inguinal hernia repairs at a 5-year followup. Strenuous work (OR: 13.7), technically challenging repairs (OR: 7.2), and chronic discomfort (OR: 6.7) were the risk factors for recurrence in their study.…”

Nárakviðslit - Yfirlitsgrein

“…Á Heilbrigðisstofnun Vesturlands á Akranesi hefur hins vegar verið starfraektur gagnagrunnur með öllum kviðslitsaðgerðum frá árinu 2004 og hafa niðurstöður úr 485 fyrstu nárakviðslitsaðgerðunum sýnt að árangur er vel sambaerilegur við það sem best gerist erlendis. 57 Til þess að haegt sé að hefja skráningu á árangri nárakviðslitsaðgerða hérlendis með miðlaegum gagnagrunni þarf þátttöku allra skurðlaekna sem framkvaema slíkar aðgerðir. Einnig er mikilvaegt að slíkur gagnagrunnur sé fjármagnaður af hinu opinbera þar sem utanumhald krefst mikillar vinnu.…”

Transplant uretero-inguinal hernia resulting in urosepsis

“…Inguinal hernias are common in the United States; with an approximated 800,000 inguinal hernia repairs performed each year [1] Inguinal hernias make up 75% of all abdominal wall hernias with two-thirds being indirect [1] , [2] . About 90% of all inguinal hernias occur in men with a broad age distribution [1] , [2] , [3] . Barring strangulated hernias, patients typically choose to wait and have an elective repair performed at a time of convenience [1] , [2] , [3] , [4] .…”