What is the outcome of re-recurrent vs recurrent inguinal hernia repairs? An analysis of 16,206 patients from the Herniamed Registry

Abstract

Introduction The proportion of recurrent repairs in the total collective of inguinal hernia repairs among men is 11.3-14.3% and among women 7.0-7.4%. The rate of re-recurrences is reported to be 2.9-9.2%. To date, no case series has been published on second and ≥ third recurrences and their treatment outcomes. Only case reports are available. Materials and methods In an analysis of data from the Herniamed Registry the perioperative and 1-year follow-up outcomes of 16,206 distinct patients who had undergone first recurrent (n = 14,172; 87.4%), second recurrent (n = 1,583; 9.8%) or ≥ third recurrent (n = 451; 2.8%) inguinal hernia repair between September 1, 2009 and July 1, 2017 were compared. Results The intraoperative complication rate for all recurrent repairs was between 1-2%. In the postoperative complications a continuous increase was observed (first recurrence: 3.97% vs second recurrence: 5.75% vs ≥ third recurrence 8.65%; p < 0.001). That applied equally to the complication-related reoperation rates (first recurrence: 1.50% vs second recurrence: 2.21% vs ≥ third recurrence 2.66; p = 0.020). Likewise, the re-recurrence rate rose significantly (first recurrence: 1.95% vs second recurrence: 2.72% vs ≥ third recurrence 3.77; p = 0.005). Similarly, the rate of pain requiring treatment rose highly significantly with an increasing number of recurrences (first recurrence: 5.21% vs second recurrence: 6.70% vs ≥ third recurrence 10.86; p = < 0.001). Conclusion The repair of re-recurrences in inguinal hernia is associated with increasingly more unfavorable outcomes. For the first recurrence the guidelines should definitely be noted. For a second and ≥ third recurrence diagnostic laparoscopy may help to select the best possible surgical technique.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Pre-operative factors associated with short- and long-term outcomes in the patient with inguinal hernia: What does the current evidence say?

“…During the literature review, a total of 13 articles, 4 systematic reviews [ [36] , [37] , [38] , [39] ], 1 narrative review [ 40 ], and 7 observational studies were found [ [41] , [42] , [43] , [44] , [45] , [46] , [47] ].…”

“…In the case of second or third recurrences, an analysis of 16,206 patients from the Herniamed Registry found that as recurrences increase, the risk of intraoperative complications increases (first recurrence, 3.97% vs. second recurrence, 5.75% vs. third recurrence, 8.65%; p < 0.001). Similarly, the risk of reoperation secondary to complications increases (first recurrence, 1.50% vs. second recurrence, 2.21% vs. third recurrence, 2.66; p = 0.020), and the need for post-operative chronic pain management increases (first recurrence, 5.21% vs. second recurrence, 6.70% vs. third recurrence, 10.86; p < 0.001) [ 45 ]. The authors concluded that for cases of second and third recurrence, diagnostic laparoscopy could be very useful in choosing the best technique, allowing the benefits vs. risks to be weighed.…”

Hérnia inguinal no Sul do Brasil - desafios no seguimento e taxas de recorrência

“…", com Índice de Youden de 0,86. Este estudo foi realizado por meio do questionário IRHV 17 18 . O motivo dessa diferença ainda não está claro e provavelmente está relacionado ao estilo de vida e atividade laboral [18][19][20] .…”

“…Este estudo foi realizado por meio do questionário IRHV 17 18 . O motivo dessa diferença ainda não está claro e provavelmente está relacionado ao estilo de vida e atividade laboral [18][19][20] . O único tratamento disponível é o cirúrgico, que deve ser considerado mesmo naqueles casos oligossintomáticos e assintomáticos, pois devido à progressão dos sintomas, 38% necessitarão de cirurgia em três anos e 70% em cinco a 10 anos, se a espera vigilante for a conduta escolhida [21][22][23] .…”

Local anesthesia as an alternative option in repair of recurrent groin hernias: An outcome study from the American College of Surgeons NSQIP® database

“…Recurrence occurs in 10–15% of cases [ 11 ], and while its prevalence is declining [ 12 ], it still presents a significant healthcare problem. Repair of a recurrent hernia can be challenging, with increased risk of complications, higher failure rates, and re-recurrence occurring in up to 8.8% of cases [ 13 , 14 ]. Due to the increased complexity of this operation, GA may be perceived to be the preferable anesthetic technique.…”