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Open preperitoneal inguinal hernia repair has superior 1-year patient-reported outcomes compared to Shouldice non-mesh repair

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Abstract

Introduction

The Shouldice method for inguinal hernia repair remains the gold standard for prosthesis-free repairs. Nonetheless, international guidelines have favored posterior mesh reinforcement as the standard of care for inguinal hernia repair due to lower risk of recurrence and chronic pain, avoidance of general anesthesia, and favorable biomechanical properties. Recent publications have shown the benefits of an open approach to posterior repairs. Herein, we use the Abdominal Core Health Quality Collaborative (ACHQC) registry to compare patient-reported outcomes after a Shouldice no-mesh repair versus open preperitoneal (OPP) mesh repair.

Methods

We performed a propensity score matched analysis to compare patient-reported quality of life (QoL) and peri/postoperative outcomes after a Shouldice repair versus OPP. Data from 2012 to 2022 were obtained from the ACHQC, and 1:1 optimal matching was performed. EuraHS scores were used to estimate QoL, and further analysis on the EuraHS domains of pain, aesthetics, and activity restriction were performed between the two cohorts.

Results

Matching resulted in 257 participants in each, Shouldice and OPP cohorts. OPP was associated with a better QoL score compared to Shouldice at 30 days after surgery (Median (IQR) 7.75 (2.0–17.0) vs 13.0 (4.0–26.1); OR 0.559 [0.37, 0.84]; p = 0.003). This difference persisted at 6 months and 1 year postoperatively (OR 0.447 [0.26, 0.75] and 0.492 [0.26, 0.93], respectively). We did not observe any significant differences in hernia recurrence risk at 1-year, or rates of 30-day SSOs/SSIs, postoperative bleeding, peripheral nerve injury, DVTs, or UTIs.

Conclusion

Our data suggest that OPP is associated with significantly better patient-reported QoL, in the first month after surgery and up to 1 year postoperatively, especially with respect to lesser pain, when compared to the Shouldice repair. In specialized inguinal hernia practices, open posterior mesh repairs may lead to better outcomes than non-mesh repairs. We encourage more training in both repairs to facilitate larger prospective studies and evaluation of the generalizability of these results to all surgeons performing IHR.

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Data availability

The data used to conduct this analysis and support the results of this paper are directly available from the ACHQC. Data requests can be made directly to the organization at: https://achqc.org/data

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Authors and Affiliations

  1. Department of Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA, USA

    Tina Bharani

  2. Department of Surgery, Massachusetts General Hospital, 55 Fruit St., GRB 425, Boston, MA, 02114, USA

    Divyansh Agarwal

  3. Boston Hernia, 20 Walnut Street, Suite 100, Wellesley, MA, 02481, USA

    Nora Fullington, Lauren Ott, Daelyn McClain, Lulu Lima & Michael Reinhorn

  4. Mass General Brigham-Newton Wellesley Hospital, Newton, MA, USA

    Nora Fullington, Lauren Ott & Michael Reinhorn

  5. Tufts University School of Medicine, Boston, MA, USA

    Michael Reinhorn

  6. Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA

    Molly Olson

  7. Center for Abdominal Core Health, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Benjamin Poulose

  8. Department of Surgery, Division of Minimal Access, and Bariatric Surgery, Prisma Health Upstate, 701 Grove Rd, ST 3, Greenville, SC, 29605, USA

    Jeremy Warren

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  1. Tina Bharani
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Correspondence to Divyansh Agarwal or Michael Reinhorn.

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This study was approved by the Institutional Review Board at Prisma Health Upstate.

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Bharani, T., Agarwal, D., Fullington, N. et al. Open preperitoneal inguinal hernia repair has superior 1-year patient-reported outcomes compared to Shouldice non-mesh repair. Hernia 28, 475–484 (2024). https://doi.org/10.1007/s10029-023-02936-3

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