2020 General Surgery Presentations

Timothy P Plackett, DO, MPH; 759th Forward Surgical Team (Airborne)

Introduction: Outcomes following inguinal hernia repairs are generally limited to 3-5 year after surgery.  These studies general show similar recurrence rates following open and laparoscopic repairs, but a quicker return to activity with a laparoscopic approach.  More long-term analysis is lacking to demonstrate if the similarities in recurrence rates hold up over time.

Methods: A single institution retrospective review was performed of all patients undergoing an inguinal hernia repair during 2008-2011.  Patients were excluded if the repair was for a recurrent inguinal hernia or if there were no post-operative records following discharge from the hospital for their index surgery.  Medical records were reviewed for patient demographics, pre-operative symptoms, type of surgical procedure, mesh used, post-operative recurrence, and post-operative pain.  Medical records were followed through July 2018 and the date of the latest clinical note was recorded.  Recurrence rates were calculated using Kaplan-Meier curves.  Comparisons between groups were made using Chi Square analysis for dichotomous variables and Student’s T-Test for continuous variable.

Results: A total of 927 patients underwent an inguinal hernia repair for an initial inguinal hernia (ie. not a recurrence).  Nine patients were excluded from further analysis for having no follow up, leaving 918 patients for analysis. 

There was no significant difference between the rate of recurrence for open versus laparoscopic repair (5.1% versus 5.9%; p = 0.681).  However, the Kaplan-Meier curve was notable for the recurrences leveling off for the open repair after 5 years, whereas laparoscopic repairs were still experiencing recurrences 10 years after repair.   There was no significant difference in recurrent rates based on age, rank, or type of mesh used. 

The presence of groin and/or testicular pain was associated with a greater incidence of chronic pain (8.1% versus 22.1%; p<0.001).  This remained true when groin and testicular pain were treated as two separate pre-operative complaints.  There was no statistically significant difference in chronic pain between open (19.4%) and laparoscopic (15.7%) repairs (p = 0.149).

Conclusions: The study demonstrates no differences in recurrence rates for open versus laparoscopic repairs for an initial inguinal hernia.  It does raise some concerns potential differences if 20-year recurrence free rates were to be followed.  There were no differences in chronic groin and/or testicular pain between either surgical approach.  However, pre-operative groin and testicular pain were a predictor of continued pain after surgery.  Further prospective studies with dedicated plans for follow examinations are needed to confirm these results.