Laparoscopic and open inguinal hernia repair: Patient reported outcomes in the elderly from a single centre - A prospective cohort study

Abstract

BackgroundWith those over 65 making up over 16% of the UK's population, surgeons are counselling increasing numbers of elderly patients for hernia repair. Data is currently lacking comparing different repair methods of inguinal hernias in the elderly population with regards to patient reported outcomes.AimTo compare open and laparoscopic hernia repair in patients >65 years old and those <65 years old with respect to patient reported outcomes.MethodAs part of a quality assurance process patients receive a telephone consultation day 2 post procedure. This includes an optional survey with questions to quantify pain, general feeling, nausea, dizziness, drowsiness, satisfaction and vomiting since the operation. Patients were then classified into age ≥ 65 years or <65 years and subclassified into totally extraperitoneal (TEP) or open inguinal hernia repair (IHR).ResultsData is presented from patients treated between January 2009 and August 2016, totalling those included 1167 of 2522 (55.5%). Only five patients (4.42%) reported moderate pain; in the >65 TEP group this was significantly lower (10.2% open IHR <65; 6.7% TEP <65; 12.8% open IHR >65). Patient satisfaction with the surgery was satisfied or very satisfied in all patients in all groups.ConclusionTime off work is not an absolute appropriate measure of return to premorbid status with respect to the elderly as a substantial number of >65 year olds have retired. We therefore present this interesting insight into patient perceptions following hernia repair by age group. Overall patients over 65 can expect the same high levels of satisfaction and low levels of pain following either technique for inguinal hernia repair as younger patients.

Surgeon utilization of minimally invasive techniques for inguinal hernia repair: a population-based study

“…[1][2][3] MIS has advantages compared to open repair regarding return to work, postoperative pain, and chronic groin pain, making its underutilization relevant to clinical and patient-centered outcomes. [4][5][6][7][8][9][10][11] While controversy may exist for unilateral hernia, the benefit of MIS over open repair is recognized for patients with bilateral or recurrent inguinal hernias, and current guidelines recommend MIS repair for these cases. [12][13][14] Nevertheless, MIS utilization in inguinal hernia repair lags behind rates for operations in colorectal, gynecologic, thoracic, bariatric, and general surgery.…”

Totally extraperitoneal inguinal hernia repair versus Lichtenstein repair: a one-year follow-up study

“…Our study confirms the hypothesis that the fixation of the mesh with sutures in group 2 is a time-consuming procedure and accounts for the majority of the operating time. Consequently, open mesh repair is much more appropriate for all varieties of inguinal hernias such as sliding, irreducible, strangulated hernia as well as for patients with co-morbidity [2].…”

Comparison of early postoperative outcome of laparoscopic and open inguinal hernia mesh repair

“…Seventy patients (35 in each group) with diagnosis of inguinal hernia were included in the study and were followed up for a period of 6 months, of which 68 were males and 2 females. Of 35 laparoscopically performed cases, TAPP was done in 19 cases and TEP in 16 cases and all open group patients underwent Lichtenstein's mesh repair.…”

“…Open mesh repair is appropriate for all varieties of inguinal hernias such as irreducible, strangulated, sliding hernia and patients with co-morbidity. 15,16 There are potential benefits for laparoscopic inguinal hernia repair over Lichtenstein's repair for unilateral inguinal hernias in terms of postoperative pain, hospital stay and early return to work. 17 This study has some limitations.…”