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Review of inguinal hernia repair techniques within the Americas Hernia Society Quality Collaborative

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Abstract

Purpose

As the ultimate procedure which each surgeon decides to perform for a unilateral uncomplicated inguinal hernia remains controversial, we queried the Americas Hernia Society Quality Collaborative (AHSQC) database to report the collective experience of surgeons in the United States whom contribute to AHSQC to provide a view of the surgical approaches performed.

Methods

The AHSQC data registry was queried for all adult patients who underwent a primary, unilateral, elective, inguinal hernia repair. A retrospective review was conducted to analyze patient demographics, hernia characteristics, operative details, and post-operative outcomes. Our main outcomes of interest were 30-day surgical site infections (SSI), surgical site occurrences (SSO), 30-day patient-reported outcomes, and 1-year recurrence rates.

Results

4613 patients met inclusion criteria. 1925 were repaired using an open technique (42%), 1841 were repaired using a laparoscopic technique (40%), and 847 were repaired using a robotic technique (18%). The Shouldice technique remains the most common tissue-based repair performed in the AHSQC. The Lichtenstein repair is the most common open mesh-based repair. Minimally invasive approaches to unilateral inguinal hernia repairs remained very common in our series. The robotic approach accounted for nearly one-third of the minimally invasive inguinal hernia repairs.

Conclusion

In general, all of the repair techniques reported similar and low rates of 30-day complications. The AHSQC continues on-going efforts to improve long-term follow-up and looks forward to addressing long-term outcomes such as recurrence and chronic pain with increasing data acquisition.

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Authors and Affiliations

  1. Comprehensive Hernia Center, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    R. AlMarzooqi, S. Tish, A. Prabhu & M. Rosen

  2. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA

    L.-C. Huang

Authors
  1. R. AlMarzooqi
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  2. S. Tish
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  3. L.-C. Huang
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  4. A. Prabhu
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  5. M. Rosen
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Corresponding author

Correspondence to R. AlMarzooqi.

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Conflict of interest

Author MR reports receiving salary support for role as medical director of non-profit AHSQC, grants from Intuitive Surgical Inc., Pacira, and Miromatrix, outside the submitted work. Author AP reports grants from Intuitive Surgical, Inc., personal fees from MedTronic, personal fees from Bard Davol, outside the submitted work. Author LH reports that the AHSQC has contracted with Vanderbilt University Department of Biostatistics to provide support for AHSQC projects. The work provided for this publication was performed under the umbrella of the Vanderbilt Biostatistics and AHSQC collaboration plan from Vanderbilt University Medical Center, during the conduct of the study. Authors RA and ST declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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This study did not require approval from the local ethical committee.

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The article is part of the Topical Collection “Forum on primary monolateral uncomplicated inguinal hernia”.

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AlMarzooqi, R., Tish, S., Huang, LC. et al. Review of inguinal hernia repair techniques within the Americas Hernia Society Quality Collaborative. Hernia 23, 429–438 (2019). https://doi.org/10.1007/s10029-019-01968-y

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  • DOI: https://doi.org/10.1007/s10029-019-01968-y

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