Surgical unit volume and recurrence after open groin hernia mesh repair: A nationwide register-based cohort study.

Multicompartment pelvic organ prolapse (POP) has a negative impact on the patient's quality of life. Abdominal mesh surgery, e.g., sacrocolporectopexy (SCRP), is favored to treat complex multicompartment POP. SCRP is known for its anatomical improvement, while functional improvement is only 70% for defecatory problems. To improve our understanding of the mesh's function, a reliable assessment in a clinically relevant position is important. The aim of this study therefore is to test the reliability of a standardized analysis method on mesh trajectory and position. A total of 25 patients treated with SCRP were included. Images were acquired with a 0.25T tiltable magnetic resonance (MR) system (G-Scan Brio, Esaote, Genoa, Italy). The mesh was annotated using three-dimensional (3D) slicer software. Annotations were performed by two observers, with different experience levels, blinded to the results of the other observer. Reliability was tested by means of the intraclass correlation coefficient (ICC) and the mean Euclidean distance (MED), with clinical relevance set at a MED difference of 10 mm. There was excellent agreement between the two observers for all mesh points (ICC = 0.97) and the lowest agreement for the anterior mesh points (ICC = 0.86) and the lowest points of the anterior mesh (ICC = 0.76). No clinically relevant difference in MED was found for all mesh points (9mm), the mesh points above the connection point (8mm), and the posterior mesh points (9mm). Upright mesh assessment is feasible and reliable on 0.25T magnetic resonance (MR) images, allowing for future mesh analysis. NL79717.091.21, 03-01-2022.

Recurrent inguinal hernia repair presents unique clinical challenges. While minimally invasive surgery (MIS) is often preferred, open anterior mesh repair is a valid approach particularly when requiring mesh, suture, or tack removal. This study evaluates the outcomes of a small incision open anterior mesh repair, including foreign body (FB) removal, in an Australian cohort. Retrospective analysis of patients who underwent open anterior mesh repair for a clinically detectable recurrent inguinal hernia at a tertiary centre. Demographics, hernia history, intraoperative findings, anaesthetic technique, complications, and follow-up symptoms were analysed. From 2001 to 2024, 173 patients were included (97.7% male, median age of 66). Swelling (54.9%) was the most common symptoms. 82.7% had a prior open repair, same-day procedures occurred in 40% and 13.3% were treated under local anaesthesia with sedation. FB removal was done in 15.6% of patients. The overall complication rate was 10.4%, wound or spermatic cord haematoma (5.2%) was the most common. At median follow-up of 35.7 months, (range 9.7-163 months), 92.3% were pain-free. Minor discomfort occurred in 7.6%, no patient reported moderate or severe pain and re-recurrence is 5.2%. No major complications occurred during FB removal. Subgroup analysis showed no significant difference in outcomes based on the prior repair approach, FB removal, or nerve management. Open anterior mesh repair for recurrent inguinal hernia is safe and effective, even after prior anterior repairs, and enables safe removal of FBs. Maintaining proficiency in open techniques is important given the increasing use of MIS in primary hernia repair.

Laparoscopic lateral suspension is an alternative to sacrocolpopexy when access to the sacral promontory is restricted or unsafe. However, prolapse recurrence may occur due to mesh arm detachment or progressive fascial attenuation. Pectineal fixation is an alternative approach that may provide a stronger, more stable anchoring vector and improved force distribution. To describe a minimally invasive salvage surgical strategy for managing recurrent anterior compartment prolapse in a patient with a history of laparoscopic lateral suspension and inaccessible sacral promontory. A 73-year-old woman presented with symptomatic vaginal bulging fifteen years after undergoing laparoscopic lateral suspension with subtotal hysterectomy and bilateral adnexectomy following an aborted promontofixation. Examination revealed a grade 2-3 cystocele and a grade 2 hysterocele without mesh exposure. Laparoscopy confirmed bilateral detachment of the anterior mesh arms from the lateral abdominal wall. Laparoscopic anterior colporrhaphy was undertaken to reinforce the pubocervical fascia, with exposure supported by a device. The detached mesh arm was carefully trimmed and then secured using non-absorbable Ethibond® 1 sutures, with one fixation point anchored to the Cooper's ligament and the other to the mesh itself, in accordance with the principles of tension-free pectopexy bilaterally. Peritonisation was completed to fully cover the mesh. Recurrent anterior prolapse after lateral suspension where the sacral promontory is inaccessible promontory can be managed by reusing the detached mesh arms and refixing to Cooper's ligament as a salvage strategy. Reinforcing the native fascia and refixing the mesh to the pectineal ligament provides an anatomically sound solution while avoiding the risks of sacral promontory dissection.

To compare the outcomes of laparoscopic pectopexy (LP) with uterine preservation between mesh placement anterior to the cervix uteri and mesh placement posterior to the cervix uteri. A retrospective cohort study of 72 women who underwent LP for stage III or IV apical pelvic organ prolapse (POP) was conducted: 48 with mesh placement anterior to the cervix (group I) and 24 with mesh placement posterior to the cervix (group II). The primary outcome was the rate of postoperative recurrences in both groups. The secondary outcome was the change in quality of life, as evaluated by comparing the results of the prolapse quality of life (P-QOL) questionnaire completed pre- and postoperatively. The mean age (58.27 ± 9.85 vs 59.04 ± 9.93years; p = 0698) and mean follow-up period (24.85 ± 5.12 vs 23.17 ± 6.93months; p = 0.323) were similar between the groups. Demographic characteristics and operative time (73.23 ± 14.10 vs 77.08 ± 29.52min, p = 0.407) were similar between the groups. No intraoperative or postoperative complications were noted in any of the groups. Recurrence (12.5% vs 8.3%, p = 0.710) and reoperation rates (4.2% vs 8.3%, p = 0.597) did not differ significantly between the groups. When the pre- and postoperative changes in the P-QOL questionnaire scores were compared between the two groups, the positive change in POP symptoms, sleep/energy, severity of symptoms and total scale score was more significant in group I. Other scale scores were similar between the two groups. In regression analysis, preoperative Ba, D, Ap and Bp points were found to be significant predictors. An increase in Ba and Ap values increased the likelihood of posterior mesh placement, while an increase in D and Bp values increased the likelihood of anterior mesh placement. In laparoscopic pectopexy, placing the mesh anterior or posterior to the cervix has similar results.

Comparison of 1-year outcomes after uterine-preserving laparoscopic pectopexy using an inverted T-shaped mesh versus the horizontal DynaMesh: A retrospective, multicenter cohort study.

Recurrent inguinal hernias and varicoceles are common surgical conditions; however, their concurrent presentation and simultaneous laparoscopic management are rarely reported. A 34-year-old male presented with swelling and discomfort in the left groin and scrotum. He had a history of open anterior mesh repair for a left inguinal hernia four years prior. Physical examination and ultrasonography confirmed a recurrent left indirect inguinal hernia and grade II varicocele. The patient was scheduled for simultaneous laparoscopic transabdominal preperitoneal (TAPP) hernia repair and varicocelectomy. Dense adhesions related to the prior anterior hernia repair were carefully dissected. A 3D polypropylene mesh was placed and fixed in the preperitoneal space, followed by peritoneal closure with a V-Loc™ suture. The dilated pampiniform plexus veins were clipped and divided using LigaSure™, sparing the testicular artery. The procedure was completed without complications, and the patient was discharged the next day with a VAS score near zero. This video case demonstrates that simultaneous laparoscopic TAPP repair and varicocelectomy can be safely performed in selected patients with dual pathology. This combined approach minimizes operative burden, avoids multiple incisions, and optimizes patient recovery.

Outcomes of Anterior Mesh Rectopexy with Sacrocolpopexy for Multi-compartment Prolapse

Laparoscopic sacrocolpopexy (LSC), which is known for its low recurrence rate, is considered the gold standard for treating pelvic organ prolapse (POP). However, in some cases, prolapse recurrence occurs even after LSC, and its cause remains unclear. Thus, the current study aimed to investigate the factors correlated with POP that contribute to postoperative prolapse recurrence. The study enrolled 95 patients who underwent LSC at our hospital between June 2016 and December 2023. The Pearson's Chi-square test, multiple logistic regression analysis, and Cox proportional hazards analysis were performed to determine the independent factors contributing to prolapse recurrence. Based on the Pearson's Chi-square test, age (≥74 or <74 years), pelvic organ prolapse staging system (4 or ≤3), and the presence of vesicovaginal adhesion were significantly correlated with prolapse recurrence (all P < 0.05). Among the preoperative and intraoperative factors, only the presence of vesicovaginal adhesion was a significant factor in the univariate and multivariate logistic regression analyses (P = 0.0034). In addition, only the presence of vesicovaginal adhesion was an independent factor of shorter time to prolapse recurrence in the multivariate Cox proportional hazards model (hazard ratio: 17.46, 95% confidence interval: 1.69-180.15, P = 0.0163). Vesicovaginal adhesion can be an independent factor of postoperative recurrence after LSC. In patients with POP undergoing LSC, particularly those with vesicovaginal adhesion, the anterior mesh may need to be fixed firmly.

Persistent postoperative pain is a major challenge in inguinal hernia surgery. However, the impact of intraoperative nerve management on postoperative pain is poorly understood. The aim was to evaluate how management of the three inguinal nerves during anterior mesh repair of inguinal hernia affects the risk for persistent postoperative pain. Cohort study based on data from the Swedish Hernia Register (SHR) concerning management of the three inguinal nerves. Adult patients with an open anterior mesh repair between 2012 and 2017 and who had responded to a patient-reported outcome measure (PROM) questionnaire one year after surgery were included in the study. Out of eligible patients, 34,115 (69%) responded to the PROM questionnaire. Of these, 25.9% reported pain that could not be ignored and 15.7% reported pain interfering with daily activities one year after surgery. Identifying and/or preserving any of the three groin nerves was not seen to have a significant impact on the risk for persistent groin pain in multivariable ordinal regression analysis adjusted for type of anaesthesia, gender, age and emergency surgery. In a setting where the nerves are handled according to the surgeon's intraoperative judgement focusing on identifying and/or preserving the nerves, there was no association between intraoperative management of the three inguinal nerves and the risk for persistent postoperative pain one year after surgery. While careful tissue handling is crucial to the avoidance of postoperative pain, pragmatic nerve resection did not increase the risk for persistent pain one year after surgery.

Background and Objectives: A surgical method is rarely very effective and simple to perform. A Lichtenstein Repair (LR) is one such exception. Because of the very high incidence of inguinal hernia, LR has become the global gold standard in inguinal hernia repair—not only due to its relative simplicity and reproducibility but also because it can be performed under local anesthesia. These attributes facilitated its worldwide adoption, including in underdeveloped and resource limited settings. Today, many variations are performed under the common name “Lichtenstein Repair”. The extent to which these modifications influence outcomes—particularly recurrence and chronic pain—remains unclear. Materials and Methods: To evaluate reasons for variation in the LR technique, a literature review of seven major surgery textbooks was performed. In addition, a questionnaire comprising 17 questions addressing the key steps of the LR was sent to 90 surgeons across 19 different hospitals in Austria (6) and Slovenia (13). The questionnaire focused on core principles described by Lichtenstein and later refined by his successors. The overall response rate was 78%. Results: Descriptions of the LR in major hernia textbooks vary substantially, partly due to the evolution of the technique over time and partly because any subaponeurotic anterior-canal mesh repair is often labeled as “Lichtenstein”. Survey responses demonstrated considerable variation and lack of standardization or uniformity in several critical steps of the LR. More than 50% of respondents reported using pre-formed meshes that they excessively trim, limiting adequate coverage of the inguinal region. Furthermore, routine patient follow-up is lacking in the majority of cases. Conclusions: The contemporary umbrella term “Lichtenstein Repair” encompasses many different anterior mesh techniques. While some surgeon-specific preferences may not compromise integrity, strict adherence to the evidence-based key principles of the original repair remains essential to minimize recurrences and chronic inguinal pain. Standardization with meticulous adherence to the key principles of the LR is critical to ensure the data submitted into registries, RCTs, and meta-analyses are accurate, comparable, and meaningful.

BackgroundInguinal hernia repair is one of the most performed surgical procedures, but, nevertheless, there is a high unmet need, with over 200 million people worldwide living with an inguinal hernia. The aims of this study were to evaluate 5-year outcomes after anterior mesh inguinal hernia repair, to assess the safety of a training intervention, and to compare the outcomes of patients operated on by a medical doctor (MD) versus an associate clinician (AC).MethodsAdult men with a primary inguinal hernia were included either as training patients or in the randomized trial, with surgical treatment performed by an MD or an AC. Patients were followed up mostly at hospital or at home; questionnaire information was collected and physical examinations were performed. Outcomes of training and trial patients were compared and outcomes of patients who underwent surgeries performed by MDs or ACs during the trial were compared.ResultsIn total, 129 patients were included in the training group and 229 patients were included in the randomized trial group. At 5-year follow-up, 288 patients (80.4%) were alive, 40 patients (11.2%) had died, and 30 patients (8.4%) were lost to follow-up. The overall recurrence rate was 5.0% and the all-cause mortality rate was 11.2%. Mortality and recurrence were not significantly different between the training and trial patients or between the patients who underwent surgeries performed by MDs or ACs during the trial.ConclusionLong-term outcomes after primary elective inguinal mesh hernia repair indicate that hands-on short-course training can be implemented effectively and that task sharing is safe and effective.

Nowadays, groin hernia repair with mesh is a gold standard procedure in western countries. Yet, foreign body reaction and mesh infection are feared complications. This study aimed to investigate the prevalence and risk factors for mesh removal due to foreign body reaction and mesh infection after groin hernia repair. This is an observational nationwide population-based register study with the use of prospectively collected data from the Swedish Hernia Register. All patients 15 years or older with a groin hernia repair registered between 1992 and 2022 were eligible. The primary outcome was the prevalence of re-surgery with mesh removal. The secondary outcome was risk factors for re-surgery with mesh removal. Of 363,664 groin hernia repairs during this 30-year-long study period, 211 (0.06%) had a re-surgery with mesh removal. The proportion of female groin hernia repairs was higher in the mesh removal group (15.2%) compared with the nonmesh removal group (7.9%). The adjusted multivariable Cox regression analysis for the risk of re-surgery with mesh removal demonstrated significantly increased hazard ratios for female (2.80, confidence interval: 1.70-4.63), emergency (3.43, confidence interval: 1.94-6.03), open anterior mesh (2.76, confidence interval: 1.61-4.72), and combined anterior/posterior mesh (predominately mesh plugs) (3.98, confidence interval: 1.84-8.57) groin hernia repairs, and for patients below the total median of 63 years (2.61, confidence interval: 1.78-3.81). The groin tissue's tolerance for an implanted mesh after a groin hernia repair can be considered high where re-surgery for mesh removal due to foreign body reaction and mesh infection is rare. Female sex, younger patients, emergency repairs, and mesh plugs were most evident associated risk factors for such re-surgery.

Most women in low- and middle-income countries lack access to laparoscopic methods for groin hernia repair; therefore, an open technique through which both inguinal and femoral hernias can be treated is needed. This could be an option in the absence or inability to use laparoscopic methods. To determine the safety and effectiveness of open anterior mesh (OAM) repair compared with modified open anterior mesh (MOAM) repair, which includes opening the transversalis fascia and covering the femoral canal with a mesh flap. This was a parallel, 2-arm, double-blind, randomized clinical trial conducted in Northern Uganda, in East Africa, at 2 public hospitals between October 2019 and February 2023. Included in the study were adult women 18 years and older with a primary groin hernia, American Society of Anesthesiologists (ASA) class I or II, and the ability to give informed consent. OAM in the control arm and MOAM in the intervention arm. The primary outcome was groin hernia recurrence 1 year postoperatively. A total of 200 participants (mean [SD] age, 52.7 [14.0] years) were included in the study; 99 (49.5%) were allocated to OAM repair, and 101 (50.5%) were allocated to MOAM repair. Nearly 45% of the participants (89 of 200) had a femoral hernia; therefore, 35 of 99 participants (35.4%) in the control arm received the intervention procedure. One year postoperatively, the overall recurrence was 5.6% (11 of 195 participants), and the intention-to-treat analysis showed that 4 of 97 participants (4.1%) in the control arm and 7 of 98 participants (7.1%) in the intervention arm had recurrence (absolute difference = -3.0 percentage points; 95% CI, -9.5 to 3.4; P = .36). Results of this randomized clinical trial demonstrate that the MOAM repair was a good option for groin hernia repair in women in low-resource settings. Femoral hernias were very common in the study population, and exposure of the femoral canal was essential to detect these hernias. ISRCTN Identifier: ISRCTN10330683.

ABSTRACTObjectiveWe aimed to study the incidence of de novo and persistent stress urinary incontinence (SUI), urodynamic stress incontinence (USI) for single incision mesh (SIM) using Calistar‐S and anterior mesh (A‐mesh) using Surelift‐A with sacrospinous fixation (SSF).MethodsPatients with Stage III or IV POP who underwent Surelift‐A + SSF (A‐mesh + SSF) or Calistar‐S (SIM) were evaluated at 1 year post‐operative and compared. The primary outcome was the emergence of post‐operative de novo and persistent SUI. Secondary outcomes included the rate of POP recurrence, quality of life, sexual function, and complications.ResultsOne hundred and seven patients underwent SIM and 122 patients with A‐mesh + SSF. 12/58 (20.7%) had de novo USI, 15/58 (25.9%) de novo SUI in SIM, while in the A‐mesh + SSF group, de novo USI developed in 3/43 (7%) and de novo SUI in 4/43 (9.3%), significantly higher with p = 0.048 and p = 0.035 respectively. Rates of persistent USI and SUI were comparable between groups. Objective cure was comparable between the two groups (96.3% vs. 97.5%, p = 0.428), subjective cure 99/107 (92%) vs. 114/122 (93.8%) for SIM vs. A‐mesh + SSF. Quality‐of‐life measures improved significantly in both groups, with greater perceived improvement in the A‐mesh + SSF group. One case of bladder injury occurred in SIM and one mesh erosion was seen in both groups.ConclusionRisk of de novo SUI and de novo USI were three‐fold higher in the SIM (Calistar‐S), however risk of persistent USI and SUI was similar. Both SIM and A‐mesh + SSF confer comparable high objective and subjective cure.

When treating anterior and apical prolapse, laparoscopic sacral colpopexy is the gold standard. Currently, it is suggested that the anterior mesh must be the lowest possible to better treat the prolapse and lower the risk of recurrence. The objective of our study was to determine the possibility of using intraoperative transperineal ultrasound measurements during laparoscopic sacral colpopexy in order to better localize the mesh positioning. We conducted a prospective double-blinded single-center study where patients included had intraoperative ultrasounds by an independent ultrasonographer, un-informed of the surgeon's clinical observations. The postoperative measures were performed by another independent ultrasonographer, which was un-informed of the intraoperative measurements. A total of 16patients were included. The anterior prosthesis was visualized in 81% of patients during laparoscopic sacral colpopexy and in all patients postoperatively. However, intraoperative measures and comparison between intraoperative and postoperative measures significantly varied. None of the patients included had a recurrence of prolapse. LEVEL OF EVIDENCE: 4.

Although OPP outcomes are more similar to those of MIS approaches, OPP is often categorized with Lichtenstein and tissue-based repairs in the broad category of &quot;open&quot; inguinal hernia repair 15 . We believe that categorizing these vastly different approaches together makes data collection and interpretation very difficult, leaving the surgical community unable to make clinically meaningful changes to improve patient outcomes. Furthermore, there are advantages of OPP compared to MIS approaches, such as decreasing cost, avoiding MIS equipment, and providing the opportunity to avoid general anesthesia 14,[25][26][27][28][29][30][31][32][33][34][35][36][37][38] . We consider open preperitoneal repairs less invasive than the standard MIS operations as they do not enter the peritoneal cavity and are performed through one 3-4 cm incision instead of multiple incisions. The current standard, particularly in the United States, requires MIS equipment and general anesthesia to perform a preperitoneal inguinal hernia repair. In our view, this has created a platform for surgeons and device companies to market expensive technologies that may offer little to no benefit to individual patients while detrimentally increasing the cost of healthcare within our society. OPP provides a solution to this dilemma but needs more widespread acceptance, training opportunities and dedicated research with appropriate classification efforts to increase evidence-based recommendations.The first step to distinguishing the benefits of OPP compared to other inguinal hernia repair techniques requires that the surgical community change the nomenclature regarding &quot;open&quot; inguinal hernia repairs. We have already done this for laparoscopic and robotic hernia surgery. We identify procedures by the anatomical planes, technology used, and location of mesh placement. We use terms like TAPP, TEP, and rTAPP to describe repairs that use laparoscopic or robotic technology to either enter the peritoneal cavity or stay in the pre-peritoneal plane. All of these procedures place mesh in the preperitoneal space and are commonly grouped together as &quot;MIS&quot; approaches in studies and publications. Similarly, several inguinal hernia repair techniques exist using an &quot;open&quot; approach. However, as previously mentioned, these approaches are significantly different from one another -both in planes dissected and placement of mesh -and have expectedly different outcomes. These open techniques must be clearly delineated in the literature and accepted in our surgical community in order to unify research efforts and guidelines. Therefore, we propose the following categorization of open inguinal hernia repair approaches:• &quot;Open tissue (OT)&quot; repairs: This dissection occurs in the space below the external oblique aponeurosis and superficial to the pre-peritoneal space. These repairs include Bassini, Shouldice, Desarda and others. • &quot;Open Anterior Mesh (OAM)&quot; repairs: This uniquely describes an anterior onlay mesh above the internal oblique musculature and deep to the external oblique aponeurosis, classically known as the Lichtenstein repair. • &quot;Open preperitoneal (OPP)&quot; repairs: Describes open approaches where mesh is placed behind the abdominal wall, in the pre-peritoneal space. Examples include: TIPP, MOPP, TREPP, Kugel and various permutations of these repairs. • &quot;Open Anterior and Posterior Mesh (OAPM)&quot; repairs: Although discouraged in international guidelines, many surgeons still utilize a hybrid technique where mesh is placed in both the anterior and posterior planes, such as Prolene Hernia System and Plug and Patch.It is crucial that we correct the generalization that all &quot;open&quot; inguinal hernia repairs are equal.We must also overcome the marketing barrier that preperitoneal repairs require a laparoscope or robot. Only then can we objectively review the outcomes associated with various repairs, and identify specific operations that offer the best value to our patients, institutions and society as a whole.Respectfully, Kaela E. Blake, MD Nora Fullington MD Michael Reinhorn MD MBA

PurposeTo compare laparoscopic sacrocolpopexy using synthetic glue for mesh fixation to laparoscopic suturing in the treatment of pelvic organ prolapse.Materials and methodsThis prospective randomized controlled trial included 54 patients with stage III or IV pelvic organ prolapse who underwent surgical correction and were allocated to two groups: a glue group which underwent laparoscopic sacrocolpopexy using synthetic cyanoacrylate glue for mesh fixation and a sutures group which underwent the same procedure using suturing for mesh fixation. Operative time, success rate, and perioperative complications were compared between the two groups. Patients were followed up at 1, 12, and 24 months postoperatively.ResultsThe median operative time was 108.8 min [83.2–155.6] in the glue group and 111.4 min [90.2–186.2] in the sutures group, without significant difference between the groups. However, the time required for anterior mesh fixation was significantly lower in the glue group compared to the sutures group (4.6 min [0.5–29.6] vs. 25.4 min [1.7–44.7], p = 0.0001). The anatomical success rates ranged from 100 to 92.6% at 1 month postoperatively, and from 88.2 to 73.7% at 24 months in the glue and sutures groups, respectively, without statistically significant difference.ConclusionsThe use of synthetic glue in laparoscopic sacrocolpopexy is a safe and effective alternative to suturing. However, larger studies with extended follow-up are required to further assess long-term efficacy and complication rates.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00345-025-05885-x.

PurposeSurgery for groin hernia is one of the most common operations in the world. Therefore, research concerning the outcomes of groin hernia surgery is extremely important both for the individual patient as well as for those providing the healthcare funding. The aim of this study is to evaluate the outcomes of hernia surgery in Sweden over a 30 year time period, from 1992 to 2021.MethodsAll groin hernia repairs in the Swedish Hernia Register between 1992 to 2021 were analyzed with emphasis on the surgical method, reoperation rate for recurrence and date of surgery, specifically 1992–2001, 2002–2011 and 2012–2021. By using personal identification numbers, a cumulative reoperation rate has been deduced for males and females separately.ResultsA total of 368,502 groin hernia operations identified in the Swedish Hernia Register between 1992 to 2021 were eligible for analysis. Since the register was begun, there have been significant changes in the choice of operative techniques, from suture repair in 1992 to open anterior mesh repair around the year 2000, until today, where an increasing proportion of hernias are repaired using laparo-endoscopic techniques. There has been a reduction in the reoperation rate for recurrence in both males and females, with the most pronounced improvement being seen in females. The laparo-endoscopic technique is associated with a reduced incidence of reoperation for recurrence in females.ConclusionGroin hernia surgery in Sweden has undergone substantial changes over the past 30 years. Reoperation for recurrence has decreased significantly during recent years, especially in females.

Inguinal hernia is a common complication following radical prostatectomy, yet preventive and therapeutic strategies remain inconsistent across specialties. Clinical questions addressing etiology, prevention, and treatment were developed through a literature review and a nationwide survey of general surgeons and urologists. Consensus recommendations were subsequently refined using the Delphi method by an expert panel. Among respondents, 66% managed more than 101 hernia cases annually, and 85% had over 20 years of surgical experience. Surgeons primarily emphasized the transversalis fascia (91%) and preperitoneal fascia (65%), whereas urologists focused on the flank pad (70%) and lateroconal fascia (67%). Most surgeons (84%) identified an association between radical prostatectomy and subsequent hernia formation, with urologists attributing causation to both patient-related and surgical factors. Repair after prostatectomy was mainly performed by open anterior approaches (80%), whereas laparoscopic transabdominal preperitoneal repair (TAPP) (20%) was less common and frequently perceived as challenging. Nearly half of respondents preferred leaving a dilated internal ring untreated, while 43% reported that preoperative hernia required no consultation. Simultaneous repair at the time of prostatectomy was rare (15%), and 72% considered prophylactic intervention unnecessary. Based on these findings, a clinical question and recommendation were formulated and, in the final Delphi round, unanimously endorsed with 100% agreement among experts. Marked specialty-based differences in perception and practice were observed. Evidence for prophylactic or simultaneous repair remains insufficient. Anterior mesh repair, or laparoscopic repair by experienced surgeons, is recommended. This consensus underscores the importance of interdisciplinary collaboration and evidence-based management of post-prostatectomy inguinal hernia.