Advertisement

Hernia

pp 1–6 | Cite as

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

  • D. R. ClydeEmail author
  • A. de Beaux
  • B. Tulloh
  • J. R. O’Neill
Original Article
  • 25 Downloads

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.

Keywords

Femoral hernia Recurrence McEvedy Mesh TEP 

Notes

Compliance with ethical standards

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.

References

  1. 1.
    Whalen HR, Kidd GA, O’Dwyer P (2011) Femoral Hernias. BMJ 343:d7668CrossRefGoogle Scholar
  2. 2.
    Andresen K, Bisgaard T, Kehlet H (2014) Reoperation rates for laparoscopic vs open repair of Femoral Hernias in Denmark: a nationwide analysis. J Am Med Assoc Surg 149(8):853–857Google Scholar
  3. 3.
    Lockhart K, Dunn D, Teo S, Ng JY, Dhillon M, Teo E, van Driel M (2018) Mesh versus non-mesh for inguinal and femoral hernia repair. Cochrane Database Syst Rev 9:CD011517Google Scholar
  4. 4.
    The HerniaSurge Group (2018) International guidelines for groin hernia management. Hernia 22(1):1–165CrossRefGoogle Scholar
  5. 5.
    Kim G, Yan So JB, Shabbir A (2017) Totally extra-peritoneal repair for acute incarcerated femoral hernia with intestinal obstruction. Int J Surg Case Rep 32:16–18CrossRefGoogle Scholar
  6. 6.
    Dahlstrand U, Wollert S, Nordin P, Sandbolm G, Gunnarsson U (2009) Emergency femoral hernia repair: a study based on a national registrar. Ann Surg 249(4):672–676CrossRefGoogle Scholar
  7. 7.
    Ge BJ, Huang Q, Liu LM, Bian HP, Fan YZ (2010) Risk factors for bowel resection and outcome in patients with incarcerated groin hernias. Hernia 14(3):259–264CrossRefGoogle Scholar
  8. 8.
    Humes DJ, Radcliffe RS, Camm C, West J (2013) Population-based study of presentation and adverse outcomes after femoral hernia surgery. Br J Surg 100(3):1827–1832CrossRefGoogle Scholar
  9. 9.
    Nilsson H, Stylianidis G, Haapamaki M, Nilsson E, Nordin P (2007) Mortality after groin hernia surgery. Ann Surg 254(4):656–660CrossRefGoogle Scholar
  10. 10.
    Bendavid R (1997) The Shouldice technique: a canon in hernia repair. Can J Surg 40(3):199–205Google Scholar
  11. 11.
    Bendavid R (1998) Complications of groin hernia surgery. Surg Clin North Am 78(6):1089–1103CrossRefGoogle Scholar
  12. 12.
    Mandalà S, La Barbera C, Callari C, Mirrabella A, Mandalà V (2018) Primary femoral hernia: open anterior treatment. In: Campanelli G (ed) The art of Hernia surgery a step-by-step guide. Springer, New York, pp 445–461CrossRefGoogle Scholar
  13. 13.
    Scott N, Go P, Graham P, McCormack K, Ross S, Grant A (2001) Open versus non-mesh for groin hernia repair. Cochrane Database Syst Rev 3:CD002197Google Scholar
  14. 14.
    McIntosh A, Hutchison A, Roberts A, Withers H (2000) Evidence-based management of groin hernia in primary care—a systematic review. Fam Pract 17:442–447CrossRefGoogle Scholar
  15. 15.
    Bay-Nielsen M, Kehlet H, Strand L, Malstrom J, Andersen FH, Wara P, Juul P, Callesen T, Danish Hernia Database Collaboration (2001) Quality assessment of 26,304 herniorrhaphies in Denmark: a prospective nationwide study. Lancet 358(9288):1124–1128CrossRefGoogle Scholar
  16. 16.
    Fuchs KH (2002) Minimally invasive surgery. Endoscopy 34(2):154–159CrossRefGoogle Scholar
  17. 17.
    O’Neill JR, Stephens NA, Save V, Kamel HM, Phillips HA, Driscoll PJ, Paterson-Brown S (2013) Defining a positive circumferential resection margin in oesophageal cancer and its implications for adjuvant treatment. Br J Surg 100(8):1055–1063CrossRefGoogle Scholar
  18. 18.
    Yalamarthi S, Kumar S, Stapleton E, Nixon SJ (2004) Laparoscopic totally extraperitoneal mesh repair for femoral hernia. J Laparoendosc Adv Surg Techn A 14:358–361CrossRefGoogle Scholar
  19. 19.
    Sorelli PG, El-Masry NS, Garett WV (2009) Open femoral hernia repair: one skin incision for all. World J Emerg Surg 4:44CrossRefGoogle Scholar
  20. 20.
    Burcharth J, Andresen K, Pommergaard HC, Bisgaard T, Rosenberg J (2014) Direct inguinal hernia and anterior surgical approach re risk factors for female inguinal hernia recurrences. Langenbeck’s Arch Surg 339(1):71–76CrossRefGoogle Scholar
  21. 21.
    Watson SD, Saye W, Hollier PA (1993) Combined laparoscopic incarcerated herniorrhaphy and small bowel resection. Surg Laparosc Endosc Percutaneous Tech 106–108(4):44Google Scholar
  22. 22.
    Rebuffat C, Galli A, Scalambra MS, Balsamo F (2006) Laparoscopic repair of strangulated hernias. Surg Endosc Other Interv Tech 20(1):131–134CrossRefGoogle Scholar
  23. 23.
    Lundstrom KJ, Holmberg H, Montgomery A, Nordin P (2018) Patient reported rates of chronic pain and recurrence after groin hernia repair. Br J Surg 105(1):106–112CrossRefGoogle Scholar
  24. 24.
    Kockerling F, Koch A, Lorenz R, Schug-Pass C, Stechemesser B, Reinpold W (2015) How long do we need to follow-up our hernia patients to find the real recurrence rate? Front Surg 2:24Google Scholar
  25. 25.
    Chan G, Chan CK (2008) Longterm results of a prospective study of 225 femoral hernia repairs: indications for tissue and mesh repair. J Am Coll Surg 207(3):360–367CrossRefGoogle Scholar
  26. 26.
    Suppiah A, Gatt M, Barandiaran J, Heng MS, Perry EP (2007) Outcomes of emergency and elective femoral hernia surgery in four district general hospitals: a 4-year study. Hernia 11(6):509–512CrossRefGoogle Scholar
  27. 27.
    Bendavid R (1989) Femoral hernias: primary versus recurrence. Int Surg J 74(2):99–100Google Scholar
  28. 28.
    Magnusson N, Nordin P, Hedberg M, Gunnarsson U, Sandbolm G (2010) The time profile of groin hernia recurrences. Hernia 14(4):341–344CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  • D. R. Clyde
    • 1
    Email author
  • A. de Beaux
    • 1
  • B. Tulloh
    • 1
  • J. R. O’Neill
    • 1
    • 2
  1. 1.Department of General SurgeryRoyal Infirmary of EdinburghEdinburghUK
  2. 2.Department of Clinical SurgeryUniversity of EdinburghEdinburghUK

Personalised recommendations