A 19\xa0year population-based cohort study analysing reoperation for recurrence following laparoscopic and open inguinal hernia repairs

G Ramsay,J O Jansen,N W Scott

doi:10.1007/s10029-019-02073-w

G Ramsay, J O Jansen + Show 1 more

Open Access

https://doi.org/10.1007/s10029-019-02073-w

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Journal: Hernia	Publication Date: Nov 30, 2019
Citations: 10	License type: open-access

Affiliation: University of Aberdeen, University of Alabama at Birmingham

Abstract

IntroductionLaparoscopic (LHR) and open (OHR) inguinal hernia repairs are both used to treat primary herniae. This study analyses the rates of operation for recurrence after laparoscopic and open inguinal hernia repair, at a population level, while considering competing risks, such as death and other operative interventions.MethodsThis is a population cohort study in Scotland. All adult patients who had a primary inguinal hernia repair in Scotland between 01/04/1996 and 01/01/2015 were included. The main outcome was recurrent operations. Cumulative incidence functions (CIF) were calculated for competing risks of death. A cox proportional hazards regression model was used to control for confounders of age, gender, bilateral herniae, deprivation and year of procedure.ResultsOf 88,590 patients, there were 10,145 LHR and 78,445 OHR. Recurrent operations were required in 1397 (1.8%) OHR and 362 (3.6%). LHR had greater hazard of recurrence than OHR (HR 1.83, 95% CI 1.61–2.08, p < 0.001). Faster time to recurrence was also associated with being older (HR for one year increase: 1.010, 95% CI 1.007–1.013, p < 0.001), being more affluent (HR 1.18, 95% CI 1.01–1.38, p = 0.04) and having a bilateral index operation (HR 2.53, 95% CI 2.22–2.88, p < 0.001).ConclusionsLHR is becoming more popular in Scotland over the past 2 decades. However, when other key confounding factors are controlled, it is associated with a higher recurrence rate.

Highlights

Laparoscopic (LHR) and open (OHR) inguinal hernia repairs are both used to treat primary herniae
Data were obtained from the Information Services Division (ISD) of the National Health Service (NHS) in Scotland, which collects hospital episode data for the whole of Scotland
The primary end-point was re-operation for recurrent inguinal hernia, electively or as an emergency. This was defined as an OPCS4 procedure code for further ipsilateral inguinal hernia repair (OPCS4 codes T21x). (If the initial operation had been a bilateral repair, a further operation on either side was included as a recurrence)

Summary

Introduction

Laparoscopic (LHR) and open (OHR) inguinal hernia repairs are both used to treat primary herniae. This study analyses the rates of operation for recurrence after laparoscopic and open inguinal hernia repair, at a population level, while considering competing risks, such as death and other operative interventions. Elective inguinal hernia repair aims to prevent these potential complications and remains one of the most commonly undertaken operations in general surgery [3]. Open hernia repair remains a commonly performed procedure. Unlike operations such as cholecystectomy, the laparoscopic technique has not superseded open operations in terms of numbers being undertaken [14]

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Results

Conclusion