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Surg Endosc. 2016 Mar;30(3):1146-55. doi: 10.1007/s00464-015-4318-3. Epub 2015 Jul 3.

Endoscopic repair of primary versus recurrent male unilateral inguinal hernias: Are there differences in the outcome?

Author information

1
Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany. ferdinand.koeckerling@vivantes.de.
2
Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
3
StatConsult GmbH, Halberstädter Strasse 40 a, 39112, Magdeburg, Germany.
4
Department of General and Visceral Surgery, German Red Cross Hospital, Lützerodestrasse 1, 30161, Hannover, Germany.
5
Hernia Center, Winghofer Medicum, Winghofer Strasse 42, 72108, Rottenburg am Neckar, Germany.

Abstract

INTRODUCTION:

To date, there are no prospective randomized studies that compare the outcome of endoscopic repair of primary versus recurrent inguinal hernias. It is therefore now attempted to answer that key question on the basis of registry data.

PATIENTS AND METHODS:

In total, 20,624 patients were enrolled between September 1, 2009, and April 31, 2013. Of these patients, 18,142 (88.0%) had a primary and 2482 (12.0%) had a recurrent endoscopic repair. Only patients with male unilateral inguinal hernia and with a 1-year follow-up were included. The dependent variables were intra- and postoperative complications, reoperations, recurrence, and chronic pain rates. The results of unadjusted analyses were verified via multivariable analyses.

RESULTS:

Unadjusted analysis did not reveal any significant differences in the intraoperative complications (1.28 vs 1.33%; p = 0.849); however, there were significant differences in the postoperative complications (3.20 vs 4.03%; p = 0.036), the reoperation rate due to complications (0.84 vs 1.33%; p = 0.023), pain at rest (4.08 vs 6.16%; p < 0.001), pain on exertion (8.03 vs 11.44%; p < 0.001), chronic pain requiring treatment (2.31 vs 3.83%; p < 0.001), and the recurrence rates (0.94 vs 1.45%; p = 0.0023). Multivariable analysis confirmed the significant impact of endoscopic repair of recurrent hernia on the outcome.

CONCLUSION:

Comparison of perioperative and 1-year outcome for endoscopic repair of primary versus recurrent male unilateral inguinal hernia showed significant differences to the disadvantage of the recurrent operation. Therefore, endoscopic repair of recurrent inguinal hernias calls for particular competence on the part of the hernia surgeon.

KEYWORDS:

Complications; Inguinal hernia; Recurrent; TAPP; TEP

PMID:
26139485
PMCID:
PMC4757618
DOI:
10.1007/s00464-015-4318-3
[Indexed for MEDLINE]
Free PMC Article

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