Outcomes of treatment for recurrent inguinal hernia: A retrospective cohort study

Abstract

CONTEXT: Inguinal hernia is a common surgical condition, with over 20 million repairs worldwide annually. Recurrent inguinal hernias occur in 14% of men and 7% of women, with recurrence rates three times higher than primary cases. Recommendations for the surgical approach to recurrent hernias lack strong evidence.

AIMS: This study examines the outcomes of recurrent inguinal hernia surgeries and the patient factors influencing the choice of surgical technique.

METHODS: We conducted a retrospective cohort study at Pirogov City Clinical Hospital (2017-2023). Patient data were collected from medical records and surveys on short-term outcomes. The focus was on recurrence rates and chronic pain syndrome (CPS). Follow-up included physical exams and ultrasound.

STATISTICAL ANALYSIS USED: Data were analyzed using MS Excel and Jamovi 2.3.21. Categorical data are shown as counts and percentages, and continuous data as median (Me) and interquartile range (Q1-Q3). Statistical tests included the Student t test, Mann-Whitney test, Pearson’s chi-square, and the log-rank test for recurrence rates. A P-value < 0.05 was considered significant.

RESULTS: A total of 187 patients had TAPP (n = 130) or Lichtenstein (n = 57) repairs. TAPP was preferred for prior mesh or non-mesh repairs, and Lichtenstein for prior TAPP. Our assessment of surgical trends showed a preference for open mesh repair in older patients (P = 0.04), those presenting with extensive hernias (P < 0.01), indirect inguinal hernias (P = 0.016), and individuals with a prior diagnosis of prostatic disorders (P < 0.01). Nevertheless, this sample of patients demonstrated a statistically significant increase in postoperative sensory disturbances (10.64%, P = 0.05). Seven recurrences (6.6%) occurred in the TAPP group, though not significantly different. Long-term outcomes were similar between groups.

CONCLUSION: The optimal surgical approach for recurrent inguinal hernia remains unclear. Patient characteristics play a significant role in surgical decision-making.

Keywords

Inguinal hernia / Lichtenstein procedure / long-term outcome / recurrence / short-term outcome / TAPP

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