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Herniotomy in young adults as an alternative to mesh repair: a retrospective cohort study

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Abstract

Introduction

Inguinal hernia repair is one of the most frequently performed procedures. An alternative to mesh repair could be herniotomy, where no mesh is placed and only minimal dissection is done. The European Hernia Society guidelines on the treatment of inguinal hernia in adult patients, which were released in 2009 and expired some time ago, states that all adult (>30 years of age) male patients with a symptomatic inguinal hernia should be operated on using a mesh technique. We hypothesize that the herniotomy is a good alternative to mesh repair in young patients.

Methods

In this retrospective cohort study, the postoperative complications and recurrence rate after a herniotomy procedure were studied. All patients between the ages of 18 and 40 at the time of the surgery were included from January 1st 1997 until December 31st 2010.

Results

In our cohort of 234 patients, the recurrence rate was 4.7 %. When we focus on the patients in the ages ranging from 18 to 25 years old at the time of the surgery, we found a recurrence rate of 0 versus 9.2 % in ages 26–40. These recurrence rates are comparable to those in current literature.

Conclusion

A herniotomy seems to be an efficient procedure with acceptable recurrence rates in patients up to 30 years of age. Postoperative pain seems to be low compared to other techniques. In patients older than 30 years recurrence rates seem to increase which necessitates the use of mesh implants. The main finding is zero recurrences in patients up to 25 years of age. Because there is a limited amount of similar studies that evaluated the complications of a herniotomy, we believe these results warrant the commencement of a randomized controlled trial to add more evidence to this topic. This cohort study is a small, but important contribution to the advice to perform a randomized controlled trial. Based on the limited evidence that is known so far, this procedure might be the treatment of choice in the repair of primary inguinal hernia in young adult patients up to 30 years of age.

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Author notes

  1. G. van Kerckhoven

    Present address: Department of Intensive Care Medicine, Amphia Medical Centre, PO Box 90158, 4800 RK, Breda, The Netherlands

  2. L. Toonen

    Present address: Department of Orthopedics, Sint Maartenskliniek, PO Box 9011, 6500 GM, Nijmegen, The Netherlands

Authors and Affiliations

  1. Department of Surgery, Meander Medical Centre, PO Box 1502, 3800 BM, Amersfoort, The Netherlands

    G. van Kerckhoven, L. Toonen, W. A. Draaisma, L. S. de Vries & P. M. Verheijen

Authors
  1. G. van Kerckhoven
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  2. L. Toonen
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  3. W. A. Draaisma
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  4. L. S. de Vries
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  5. P. M. Verheijen
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Corresponding author

Correspondence to P. M. Verheijen.

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Conflict of interest

GK declares no conflict of interest. LT declares no conflict of interest. WD declares no conflict of interest. LV declares no conflict of interest. PV declares no conflict of interest.

Ethical approval

All procedures in the study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

Informed consent

Since our study is a retrospective study no formal consent is required.

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van Kerckhoven, G., Toonen, L., Draaisma, W.A. et al. Herniotomy in young adults as an alternative to mesh repair: a retrospective cohort study. Hernia 20, 675–679 (2016). https://doi.org/10.1007/s10029-016-1529-z

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  • DOI: https://doi.org/10.1007/s10029-016-1529-z

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