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Minimising recurrence after primary femoral hernia repair; is mesh mandatory?

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Abstract

Purpose

The recent international hernia guidelines advocate laparoscopic pre-peritoneal mesh repair for primary femoral hernias. However, no randomised trial has demonstrated a lower recurrence rate compared to suture repair. This study aimed to determine the 5-year recurrence rate following femoral hernia repair, in elective and emergency settings, according to surgical approach (open or laparoscopic) and method (suture, suture + mesh, or mesh alone).

Methods

Consecutive patients undergoing primary femoral hernia repairs within a single health board, between 2007 and 2013, were identified from a prospective audit. Patients who had died or were uncontactable during the period of follow-up were excluded. Recurrence was defined as the clinical suspicion of an ipsilateral groin hernia at outpatient review or patient reported ipsilateral groin swelling.

Results

A total of 297 patients underwent primary femoral hernia repairs in the time period. Of the 138 cases with complete follow-up, 25 patients experienced recurrence at 5 years (18%), with 60% of recurrences evident within the first post-operative year. The median follow-up of the remaining 113 patients was 93 months (range 63–127). No difference could be detected in recurrence rates (P = 0.372, P = 0.353), or time to recurrence (P = 0.421, P = 0.295), according to repair type (suture only, suture and mesh, or mesh only) or surgical approach (high open, low open and laparoscopic pre-peritoneal), respectively.

Conclusions

Use of different surgical approaches and types of repair for primary presentations of femoral hernia did not affect the recurrence rate or time to recurrence. Use of a pre-peritoneal mesh did not alter the recurrence rate or recurrence free survival, in either elective or emergency settings, compared to simple suture repair. Recurrence following primary femoral hernia repair tends to occur within the first post-operative year, suggesting that technical factors may be as important as suture or mesh failure.

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Authors and Affiliations

  1. Department of General Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK

    D. R. Clyde, A. de Beaux, B. Tulloh & J. R. O’Neill

  2. Department of Clinical Surgery, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK

    J. R. O’Neill

Authors
  1. D. R. Clyde
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  2. A. de Beaux
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  3. B. Tulloh
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  4. J. R. O’Neill
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Correspondence to D. R. Clyde.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was classified as an audit of clinical outcome and, therefore, ethical approval was not required.

Human and animal rights

No animals were used in this study. There are no concerns regarding any compromise or challenge of human rights.

Informed consent

All patients who participated in this study gave informed verbal consent at the time of telephone follow-up.

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Clyde, D.R., de Beaux, A., Tulloh, B. et al. Minimising recurrence after primary femoral hernia repair; is mesh mandatory?. Hernia 24, 137–142 (2020). https://doi.org/10.1007/s10029-019-02007-6

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  • DOI: https://doi.org/10.1007/s10029-019-02007-6

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