Factors associated with hernia recurrence after laparoscopic total extraperitoneal repair for inguinal hernia: a 2-year prospective cohort study.

Abstract

Laparoscopic total extraperitoneal repair (TEP) of inguinal hernia has been associated with higher rates of recurrence compared to open methods. The aim of the present study was to determine independent risk factors for recurrence within 2years after TEP. This was a single-centre prospective cohort study with consecutive inclusion of patients undergoing inguinal hernia repair from 2010 to 2014. Systematic follow-up was conducted 6months and 2years postoperatively. Risk factors for recurrence after 2years were analysed in univariate and multivariate analyses. A total of 1194 patients underwent TEP for inguinal or femoral hernia in the study period, of which 1047 were eligible for analyses. After 2years, 56 (5.3%) patients had presented with recurrence. The following factors were associated with recurrence in univariate analyses: body mass index (BMI) >30 (HR 3.64; p=0.011), medial vs. lateral hernia (HR 2.37; p=0.004), repair of recurrent hernia vs. primary repair (HR 2.12; p=0.049), and length of stay >1day (HR 1.77; p=0.043). In multivariate analyses, factors independently associated with recurrence after 2years were BMI >30 (HR 3.74; p=0.026) and medial vs. lateral hernia (HR 2.39; p=0.004). The recurrence rate after TEP is higher than reported after open hernia repair. Attempts to decrease the rate should be persuaded. Good surgical technique with precise dissection and correct placement of the mesh, especially in medial hernias and obese patients, may be key points to improve outcomes after TEP.