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Factors associated with hernia recurrence after laparoscopic total extraperitoneal repair for inguinal hernia: a 2-year prospective cohort study

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A Comment to this article was published on 01 September 2017

Abstract

Background

Laparoscopic total extraperitoneal repair (TEP) of inguinal hernia has been associated with higher rates of recurrence compared to open methods. The aim of the present study was to determine independent risk factors for recurrence within 2 years after TEP.

Methods

This was a single-centre prospective cohort study with consecutive inclusion of patients undergoing inguinal hernia repair from 2010 to 2014. Systematic follow-up was conducted 6 months and 2 years postoperatively. Risk factors for recurrence after 2 years were analysed in univariate and multivariate analyses.

Results

A total of 1194 patients underwent TEP for inguinal or femoral hernia in the study period, of which 1047 were eligible for analyses. After 2 years, 56 (5.3%) patients had presented with recurrence. The following factors were associated with recurrence in univariate analyses: body mass index (BMI) >30 (HR 3.64; p = 0.011), medial vs. lateral hernia (HR 2.37; p = 0.004), repair of recurrent hernia vs. primary repair (HR 2.12; p = 0.049), and length of stay >1 day (HR 1.77; p = 0.043). In multivariate analyses, factors independently associated with recurrence after 2 years were BMI >30 (HR 3.74; p = 0.026) and medial vs. lateral hernia (HR 2.39; p = 0.004).

Conclusion

The recurrence rate after TEP is higher than reported after open hernia repair. Attempts to decrease the rate should be persuaded. Good surgical technique with precise dissection and correct placement of the mesh, especially in medial hernias and obese patients, may be key points to improve outcomes after TEP.

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Authors and Affiliations

  1. Department of Surgery, Diakonhjemmet Hospital, PO Box 23, Vinderen, 0319, Oslo, Norway

    L. Schjøth-Iversen, A. Refsum & K. W. Brudvik

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  1. L. Schjøth-Iversen
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  2. A. Refsum
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  3. K. W. Brudvik
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Correspondence to L. Schjøth-Iversen.

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LSI declares no conflict of interest. AR declares no conflict of interest. KWB declares no conflict of interest.

Ethical approval

The study was approved by the local research ethics committee (REC).

Human and animal rights

Compliance with ethical standards was adhered to through Institutional Review Board approval and the study including human participants have been performed in accordance with the ethical standards of the Declaration of Helsinki and its later amendments.

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All patients were included after written informed consent.

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Schjøth-Iversen, L., Refsum, A. & Brudvik, K.W. Factors associated with hernia recurrence after laparoscopic total extraperitoneal repair for inguinal hernia: a 2-year prospective cohort study. Hernia 21, 729–735 (2017). https://doi.org/10.1007/s10029-017-1634-7

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