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Surgical Endoscopy

, Volume 33, Issue 1, pp 71–78 | Cite as

Laparoscopic repair is superior to open techniques when treating primary groin hernias in women: a nationwide register-based cohort study

  • Line SchmidtEmail author
  • Stina Öberg
  • Kristoffer Andresen
  • Jacob Rosenberg
Article

Abstract

Background

Few studies have described recurrence rates after groin hernia repair in women. Our aim was to investigate if laparoscopic repair of primary groin hernias in women results in a lower reoperation rate for recurrence compared with open repairs. Furthermore, we wished to compare hernia subtypes at primary repair and reoperation.

Methods

This nationwide cohort study was reported according to the RECORD statement. We used prospectively collected data from the Danish Hernia Database to generate a cohort of females operated for a primary groin hernia from 1998 to 2017. Our primary outcome was reoperation for recurrence. The secondary outcome was subtype of hernia at primary repair and reoperation. All females had at least 6-month follow-up.

Results

We included 13,945 primary groin hernia operations in women, of whom 649 had undergone a reoperation for recurrence. Median follow-up time was 8.8 years. The cumulative reoperation rates were lower after laparoscopic repair compared with the open techniques, for both inguinal hernias (1.8 vs. 6.3%, p < 0.001) and femoral hernias (2.2 vs. 5.5%, p = 0.005). After laparoscopic repair, 25% of inguinal hernias recurred as femoral, compared with 47% after Lichtenstein (p < 0.001). Direct inguinal hernias and femoral hernias had higher risk of reoperation for recurrence after open repair compared with indirect inguinal hernias. For laparoscopic procedures, hernia subtypes at the primary groin hernia repair had similar reoperation rates.

Conclusion

Laparoscopic repair of primary groin hernia in women had lower reoperation rates and fewer femoral recurrences than open repair techniques.

Keywords

Inguinal Femoral Hernia Female Surgery Database 

Notes

Funding

This study received no financial support from extramural sources.

Compliance with ethical standards

Disclosures

Mr. Andresen reports personal fees from C.R. Bard, Inc. outside the submitted work. Mr. Rosenberg reports personal fees from C.R. Bard, Inc. and Merck & Co., Inc. outside the submitted work. Ms. Schmidt and Ms. Öberg have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Burcharth J, Pedersen M, Bisgaard T, Pedersen C, Rosenberg J (2013) Nationwide prevalence of groin hernia repair. PLoS ONE 8:e54367CrossRefGoogle Scholar
  2. 2.
    Weber A, Valencia S, Garteiz D, Burguess A (2001) Epidemology of hernias in the female. In: Bendavid R, Abrahamson J, Arregui ME, Flament JB, Phillips EH (eds) Abdominal wall hernias: principles and management. Springer, New York, pp 613–619CrossRefGoogle Scholar
  3. 3.
    Nilsson H, Stylianidis G, Haapamaki M, Nilsson E, Nordin P (2007) Mortality after groin hernia surgery. Ann Surg 245:656–660CrossRefGoogle Scholar
  4. 4.
    Kingsnorth A (2004) Treating inguinal hernias. BMJ 328:59–60CrossRefGoogle Scholar
  5. 5.
    Andresen K, Rosenberg J (2017) Open preperitoneal groin hernia repair with mesh: a qualitative systematic review. Am J Surg 213:1153–1159CrossRefGoogle Scholar
  6. 6.
    Kuhry E, van Veen RN, Langeveld HR, Steyerberg EW, Jeekel J, Bonjer HJ (2007) Open or endoscopic total extraperitoneal inguinal hernia repair? A systematic review. Surg Endosc 21:161–166CrossRefGoogle Scholar
  7. 7.
    Burcharth J, Andresen K, Pommergaard HC, Bisgaard T, Rosenberg J (2014) Direct inguinal hernias and anterior surgical approach are risk factors for female inguinal hernia recurrences. Langenbecks Arch Surg 399:71–76CrossRefGoogle Scholar
  8. 8.
    Koch A, Edwards A, Haapaniemi S, Nordin P, Kald A (2005) Prospective evaluation of 6895 groin hernia repairs in women. Br J Surg 92:1553–1558CrossRefGoogle Scholar
  9. 9.
    Nilsson H, Holmberg H, Nordin P (2017) Groin hernia repair in women: a nationwide register study. Am J Surg.  https://doi.org/10.1016/j.amjsurg.2017.07.027 Google Scholar
  10. 10.
    Bay-Nielsen M, Kehlet H (2006) Inguinal herniorrhaphy in women. Hernia 10:30–33CrossRefGoogle Scholar
  11. 11.
    Jess P, Hauge C, Hansen CR (1999) Long-term results of repair of the internal ring for primary inguinal hernia. Eur J Surg 165:748–750CrossRefGoogle Scholar
  12. 12.
    Schouten N, Burgmans JP, van Dalen T, Smakman N, Clevers GJ, Davids PH, Verleisdonk EJ, Elias SG, Simmermacher RK (2012) Female ‘groin’ hernia: totally extraperitoneal (TEP) endoscopic repair seems the most appropriate treatment modality. Hernia 16:387–392CrossRefGoogle Scholar
  13. 13.
    Benchimol EI, Smeeth L, Guttmann A, Harron K, Moher D, Petersen I, Sorensen HT, von Elm E, Langan SM (2015) The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement. PLoS Med 12:e1001885CrossRefGoogle Scholar
  14. 14.
    Friis-Andersen H, Bisgaard T (2016) The Danish Inguinal Hernia database. Clin Epidemiol 8:521–524CrossRefGoogle Scholar
  15. 15.
    Pedersen CB, Gotzsche H, Moller JO, Mortensen PB (2006) The Danish Civil Registration System: a cohort of eight million persons. Dan Med Bull 53:441–449Google Scholar
  16. 16.
    Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M (2009) European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 13:343–403CrossRefGoogle Scholar
  17. 17.
    The HerniaSurge Group (2018) International guidelines for groin hernia management. Hernia 22:1–165CrossRefGoogle Scholar
  18. 18.
    Kocijan R, Sandberg S, Chan YW, Hollinsky C (2010) Anatomical changes after inguinal hernia treatment: a reason for chronic pain and recurrent hernia? Surg Endosc 24:395–399CrossRefGoogle Scholar
  19. 19.
    Putnis S, Wong A, Berney C (2011) Synchronous femoral hernias diagnosed during endoscopic inguinal hernia repair. Surg Endosc 25:3752–3754CrossRefGoogle Scholar
  20. 20.
    Henriksen NA, Thorup J, Jorgensen LN (2012) Unsuspected femoral hernia in patients with a preoperative diagnosis of recurrent inguinal hernia. Hernia 16:381–385CrossRefGoogle Scholar
  21. 21.
    Mikkelsen T, Bay-Nielsen M, Kehlet H (2002) Risk of femoral hernia after inguinal herniorrhaphy. Br J Surg 89:486–488CrossRefGoogle Scholar
  22. 22.
    Burcharth J, Pommergaard HC, Bisgaard T, Rosenberg J (2015) Patient-related risk factors for recurrence after inguinal hernia repair: a systematic review and meta-analysis of observational studies. Surg Innov 22:303–317CrossRefGoogle Scholar
  23. 23.
    Nolsoe A, Andresen K, Rosenberg J (2016) Repair of recurrent hernia is often performed at a different clinic. Hernia 20:783–787CrossRefGoogle Scholar
  24. 24.
    Eklund AS, Montgomery AK, Rasmussen IC, Sandbue RP, Bergkvist LA, Rudberg CR (2009) Low recurrence rate after laparoscopic (TEP) and open (Lichtenstein) inguinal hernia repair: a randomized, multicenter trial with 5-year follow-up. Ann Surg 249:33–38CrossRefGoogle Scholar
  25. 25.
    Feliu-Pala X, Martin-Gomez M, Morales-Conde S, Fernandez-Sallent E (2001) The impact of the surgeon’s experience on the results of laparoscopic hernia repair. Surg Endosc 15:1467–1470CrossRefGoogle Scholar
  26. 26.
    Kald A, Nilsson E, Anderberg B, Bragmark M, Engstrom P, Gunnarsson U, Haapaniemi S, Lindhagen J, Nilsson P, Sandblom G, Stubberod (1998) A reoperation as surrogate endpoint in hernia surgery: a three year follow-up of 1565 herniorrhaphies. Eur J Surg 164:45–50CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Center for Perioperative Optimization, Department of SurgeryHerlev Hospital, University of CopenhagenCopenhagenDenmark

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