Performing total extraperitoneal inguinal hernia repair in patients with previous abdominal surgery is safe: an analysis of 1591 patients

Abstract

Abstract Objective The safety of endoscopic total extraperitoneal inguinal hernia repair (TEP) in patients who previously underwent open lower abdominal surgery has been discussed for many years, since operative difficulties can be expected due to adhesions and scarring. Some research has been done in this area, most of which ask for further studies to be conducted. The aim of this study was to assess the safety and feasibility of TEP in patients with previous lower abdominal surgery (PLAS). Methods We retrospectively analysed all patients who underwent a TEP inguinal hernia repair at our institution between July 2012 and May 2018. Previous lower abdominal surgery (PLAS) was defined as any previous open surgery with scarring below the umbilicus. In case of scars outside the midline, these were defined as PLAS when on the same side as the operated inguinal hernia. A univariate analysis as well as logistic regression were performed to identify outcomes of surgery between patients with- and without PLAS. Results In total 1591 patients were included in the study. 274 patients had PLAS, corresponding to 17.2%. Comparing to patients without PLAS, the group with PLAS had a significant higher risk of increased operation duration (odds ratio 1.07, p-value 0.004), but no increased risk of conversion, or intra- or postoperative complications. The highest significant risk of increasing operation duration was found after aortoiliac surgery (OR 2.08), bladder surgery (OR 1.71) or prostate surgery (odds ratio 1.22). Conclusion Performing TEP inguinal hernia repair after lower abdominal surgery slightly increases the operation duration, however there is no negative effect on the length of stay and the complication- or conversion rate. Therefore, we consider TEP to be a feasible and safe operation technique also for patients who previously underwent open lower abdominal surgery.