Minimally invasive inguinal hernia repair is superior to open: a national database review.

PURPOSE: Many publications have focused on single-surgeon or single-center data, comparing surgical approach in inguinal hernia repair. This study evaluated outcomes in patients who underwent open (OIHR), laparoscopic (LIHR) or robotic (RIHR) inguinal hernia repair using a national database. METHODS: The Vizient clinical database was queried using ICD-9 and ICD-10 procedure and diagnosis codes for RIHR, LIHR, and OIHR from 2013 to 2017. Elective procedures classified as minor or moderate risk severity were included. Complications, 30-day readmission, mortality, LOS, and intra-hospital opiate utilization were analyzed using IBM SPSS v.23.0. RESULTS: 3547 patients (OIHR: N = 2413, LIHR: N = 540, RIHR: N = 594) were included in the study. Majority were male (OIHR 84.1%, LIHR 80.4%, RIHR 95.3%), ≥ 51 years (OIHR 81.5%, LIHR 81.7%, RIHR 95.3%), and Caucasian (OIHR 75.7%, LIHR 77.0%, RIHR 81.5%). RIHR had the least overall complications (0.67%) compared to LIHR (4.44%) and OIHR (3.85%), p < 0.05. OIHR had the highest postoperative infection rate (8.33%), versus LIHR (0.56%) and RIHR (0.0%), p < 0.05. OIHR had longer length of stay (3.57 ± 4.1 days) when compared to both groups (LIHR 2.2 ± 2.13 days, RIHR 1.75 ± 1.62 days), p < 0.001. OIHR had higher 30-day readmission rates (3.61%) compared to RIHR (0.84%), p = 0.001. Mortality was similar between groups (OIHR 0.21%, LIHR 0.19%, RIHR 0.17%), p = 0.081. Opiate use was higher with OIHR (96.0%), compared to both LIHR (93.1%), and RIHR (93.8%), p = 0.004. CONCLUSION: RIHR outcomes were improved compared to OIHR or LIHR. OIHR had the highest rate of opiate use, there was no difference between LIHR and RIHR. Further studies are needed to determine the role of RIHR and to assess whether surgeon or patient selection contributes to outcomes.

Identifying patients at risk for urinary retention following inguinal herniorrhaphy: a single institution study.

PURPOSE: We aim to identify patients at risk for post-operative urinary retention (POUR) and factors associated with POUR. METHODS: Males who underwent inguinal hernia repair (IHR) from June 2010 to September 2014 at a single institution were grouped according to the presence (symptomatic) or absence (asymptomatic) of preoperative urogenital symptoms (UGS). Patients ≤ 18 years of age were excluded. POUR was defined as the need to catheterize a patient who had not voided 6 h after surgery. Data were examined using IBM SPSS v23.0. RESULTS: Of the 60 asymptomatic and 30 symptomatic patients identified, no differences were seen in age (55 vs. 65, p = 0.13), length of stay > 1 day (3% vs. 13%, p = 0.09), bilateral inguinal herniation (23% vs. 23%, p = 1.00), or laparoscopic approach (70% vs. 69%, p = 1.00); however, significant differences were seen in POUR (5% vs. 27%, p = 0.01) and α-blocker utilization (50% vs. 80%, p = 0.01). When age-matched, neither POUR (10% vs. 27%, p = 0.10) or α-blocker utilization (57% vs. 80%, p = 0.05) significantly differed between asymptomatic and symptomatic patients, respectively. Logistic regression analysis demonstrated that only bilateral inguinal herniation (OR 6.55, p = 0.03) and symptoms (OR 6.78, p = 0.02) were associated with POUR. Asymptomatic patients with a unilateral hernia have a 4.3% risk of POUR, whereas symptomatic patients with a bilateral inguinal hernia have at 57.1% risk. CONCLUSIONS: We demonstrate that bilateral inguinal herniation and UGS independently increase the risk of POUR, whereas α-blockers do not. For the general surgical population, α-blockers should not be routinely prescribed to all patients and instead should be limited to high-risk patients.