Surgical approach for recurrent inguinal hernias: a Nationwide Cohort Study.
Hernia
; 20(6): 777-782, 2016 Dec.
Article
in En
| MEDLINE
| ID: mdl-27604381
ABSTRACT
PURPOSE:
Guidelines recommend that the reoperation of a recurrent inguinal hernia should be by the opposite approach (anterior-posterior) than the primary repair. However, the level of evidence supporting the guidelines is partially low. The purpose of this study was to compare re-reoperation rates between repairs performed according to the guidelines with the ones performed against it.METHODS:
This cohort study was based on the Danish Hernia Database, including 4344 patients with two inguinal hernia repairs in the same groin. Four groups were compared as follows Lichtenstein-Lichtenstein vs. Lichtenstein-Laparoscopy, and Laparoscopy-Laparoscopy vs. Laparoscopy-Lichtenstein. The outcome was re-reoperation rates, which were compared by crude rates, cumulated rates, and hazard ratios.RESULTS:
There was no difference in the re-reoperation rates when the primary repair was laparoscopic, regardless of the type of reoperation. However, Lichtenstein-Lichtenstein had a significantly higher re-reoperation rate compared with Lichtenstein-Laparoscopy (crude rate 8.7 vs. 3.1 %, p value <0.0005; Hazard Ratio 2.46, 95 % CI 1.76-3.43). Further analysis showed that the higher risk of re-reoperation for Lichtenstein-Lichtenstein was only seen if the primary hernia was medial.CONCLUSIONS:
A primary Lichtenstein repair of a primary medial hernia should be reoperated with a laparoscopic repair. A primary Lichtenstein repair of a primary lateral hernia can be reoperated with either a Lichtenstein or a laparoscopic repair according to surgeon's choice. For a primary laparoscopic operation, the method of repair of a recurrent hernia did not affect the re-reoperation rate.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Herniorrhaphy
/
Hernia, Inguinal
Type of study:
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Risk_factors_studies
Limits:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
Europa
Language:
En
Journal:
Hernia
Journal subject:
GASTROENTEROLOGIA
Year:
2016
Document type:
Article
Affiliation country:
Denmark