Recurrences after conventional anterior and laparoscopic inguinal hernia repair: a randomized comparison

Abstract

Objective: To study the long-term recurrence rate and other complications after conventional and laparoscopic inguinal hernia repair.

Summary background data: Reliable long-term follow-up of patients with inguinal hernias treated by laparoscopic repair techniques is lacking.

Methods: The authors performed a randomized, multicenter trial in which 487 patients with inguinal hernia were treated by totally extraperitoneal laparoscopic repair and 507 patients were treated by conventional anterior hernia repair. Patients were followed and examined for recurrence and chronic inguinal pain 2, 3, and 5 years after surgery. Risk factors for recurrence and chronic inguinal pain were assessed.

Results: Patients who underwent conventional repair had a high risk for recurrence compared to patients who underwent laparoscopic repair. Risk factors for recurrence were operative time and type of conventional repair. Predictive independent risk factors for chronic inguinal pain were conventional repair (Bassini repairs and non-bassini repairs), inguinal pain before surgery, and perioperative lesion of the ilioinguinal nerve.

Conclusions: Patients with inguinal hernia who undergo laparoscopic repair have fewer recurrences and less chronic inguinal pain than those who undergo conventional open repair. The Bassini repair produces unacceptably high recurrence rates.

Figure 1. Kaplan-Meier curves for recurrences for patients operated in the open surgery (continuous line) and the laparoscopic surgery group (dotted line) (log rank;P = .006). Median follow-up: 44 months (interquartile range 28 to 50). The numbers of pateints at risk are presented above.