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Hernia. 2020 Feb 21. doi: 10.1007/s10029-020-02138-1. [Epub ahead of print]

What is the outcome of re-recurrent vs recurrent inguinal hernia repairs? An analysis of 16,206 patients from the Herniamed Registry.

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
Immanuel Hospital Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf, Germany.
3
Spital Riggisberg, Inselgruppe,, Eyweg 2, 3132, Riggisberg, Switzerland.
4
DRK-Krankenhaus Clementinenhaus, Lützerodestr. 1, 30161, Hannover, Germany.
5
StatConsult GmbH, Halberstädter Strasse 40 a, 39112, Magdeburg, Germany.
6
Pan Hospital, Hernia Center, Zeppelinstraße 1, 50667, Köln, Germany.
7
Hansechirurgie, Niebuhr, Marleschki & Partner, Alte Holstenstr. 16, 21031, Hamburg, Germany.
8
COPV-Hernia Center, Kaiser-Wilhelm-Str. 24-26, 12247, Berlin, Germany.
9
Vivantes Humboldt Hospital, Am Nordgraben 2, 13509, Berlin, Germany.

Abstract

INTRODUCTION:

The proportion of recurrent repairs in the total collective of inguinal hernia repairs among men is 11.3-14.3% and among women 7.0-7.4%. The rate of re-recurrences is reported to be 2.9-9.2%. To date, no case series has been published on second and ≥ third recurrences and their treatment outcomes. Only case reports are available.

MATERIALS AND METHODS:

In an analysis of data from the Herniamed Registry the perioperative and 1-year follow-up outcomes of 16,206 distinct patients who had undergone first recurrent (n = 14,172; 87.4%), second recurrent (n = 1,583; 9.8%) or ≥ third recurrent (n = 451; 2.8%) inguinal hernia repair between September 1, 2009 and July 1, 2017 were compared.

RESULTS:

The intraoperative complication rate for all recurrent repairs was between 1-2%. In the postoperative complications a continuous increase was observed (first recurrence: 3.97% vs second recurrence: 5.75% vs ≥ third recurrence 8.65%; p < 0.001). That applied equally to the complication-related reoperation rates (first recurrence: 1.50% vs second recurrence: 2.21% vs ≥ third recurrence 2.66; p = 0.020). Likewise, the re-recurrence rate rose significantly (first recurrence: 1.95% vs second recurrence: 2.72% vs ≥ third recurrence 3.77; p = 0.005). Similarly, the rate of pain requiring treatment rose highly significantly with an increasing number of recurrences (first recurrence: 5.21% vs second recurrence: 6.70% vs ≥ third recurrence 10.86; p = < 0.001).

CONCLUSION:

The repair of re-recurrences in inguinal hernia is associated with increasingly more unfavorable outcomes. For the first recurrence the guidelines should definitely be noted. For a second and ≥ third recurrence diagnostic laparoscopy may help to select the best possible surgical technique.

KEYWORDS:

Chronic pain; Inguinal hernia; Outcome; Postoperative complications; Re-recurrence; Recurrence

PMID:
32086633
DOI:
10.1007/s10029-020-02138-1

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