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Direct inguinal hernias and anterior surgical approach are risk factors for female inguinal hernia recurrences.
Langenbecks Arch Surg. 2014 Jan; 399(1):71-6.LA

Abstract

PURPOSE

The purpose of this study was to establish the risk of recurrence after direct and indirect inguinal hernia operation in a large-scale female population and to establish the relationship between the type of hernia at the primary and recurrent procedure.

METHODS

Using data from the Danish Hernia Database (DHDB), a cohort was generated: all females operated on electively for a primary inguinal hernia by either Lichtenstein’s technique or laparoscopy from 1998 to 2012. Within this prospectively collected cohort, the hernia type at the primary procedure (direct inguinal hernia (DIH), indirect inguinal hernia (IIH), combination hernia), the hernia type at the recurrent procedure (DIH, IIH, combination hernia, femoral hernia), anesthesia type, and time from primary procedure to reoperation were registered.

RESULTS

A total of 5,893 females with primary elective inguinal hernia operation on in the study period (61 % IIH, 37 % DIH, 2 % combined hernias) were included with a median follow-up time of 72 months (range 0 to 169). A total of 305 operations for suspected recurrences were registered (61 % inguinal recurrences, 38 % femoral recurrences, 1 % no hernias), which corresponded to an overall reoperation rate of 5.2 %. All femoral recurrences occurred after a previous open anterior operation. The crude reoperation rate after primary DIH operation was 11.0 %, 3.0 % after primary IIH operation and 0.007 % after combined hernia operation (p < 0.001). The multivariate adjusted analysis found that DIH at primary operation was a substantial risk factor for recurrence with a hazard ratio of 3.1 (CI 95 % 2.4–3.9) compared with IIH at primary operation (p < 0.001), and that laparoscopic operation gave a lower risk of recurrence with a hazard ratio of 0.57 (CI 95 % 0.43–0.75) compared with Lichtenstein’s technique (p < 0.001). The risk of femoral recurrence was correlated to operation for DIH with a hazard ratio of 2.4 (CI 95 % 1.7–3.5) compared with operation for IIH.

CONCLUSION

In a female nationwide prospectively gathered cohort, we found that operation for a DIH resulted in a higher risk of reoperation than operation for an IIH. We found that femoral hernia recurrences exclusively existed after anterior open primary operation.

Authors

No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

24077676

Citation

Burcharth, Jakob, et al. "Direct Inguinal Hernias and Anterior Surgical Approach Are Risk Factors for Female Inguinal Hernia Recurrences." Langenbeck's Archives of Surgery, vol. 399, no. 1, 2014, pp. 71-6.
Burcharth J, Andresen K, Pommergaard HC, et al. Direct inguinal hernias and anterior surgical approach are risk factors for female inguinal hernia recurrences. Langenbecks Arch Surg. 2014;399(1):71-6.
Burcharth, J., Andresen, K., Pommergaard, H. C., Bisgaard, T., & Rosenberg, J. (2014). Direct inguinal hernias and anterior surgical approach are risk factors for female inguinal hernia recurrences. Langenbeck's Archives of Surgery, 399(1), 71-6.
Burcharth J, et al. Direct Inguinal Hernias and Anterior Surgical Approach Are Risk Factors for Female Inguinal Hernia Recurrences. Langenbecks Arch Surg. 2014;399(1):71-6. PubMed PMID: 24077676.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Direct inguinal hernias and anterior surgical approach are risk factors for female inguinal hernia recurrences. AU - Burcharth,Jakob, AU - Andresen,Kristoffer, AU - Pommergaard,Hans-Christian, AU - Bisgaard,Thue, AU - Rosenberg,Jacob, PY - 2013/06/05/received PY - 2013/09/15/accepted PY - 2013/10/1/entrez PY - 2013/10/1/pubmed PY - 2014/9/23/medline SP - 71 EP - 6 JF - Langenbeck's archives of surgery JO - Langenbecks Arch Surg VL - 399 IS - 1 N2 - PURPOSE: The purpose of this study was to establish the risk of recurrence after direct and indirect inguinal hernia operation in a large-scale female population and to establish the relationship between the type of hernia at the primary and recurrent procedure. METHODS: Using data from the Danish Hernia Database (DHDB), a cohort was generated: all females operated on electively for a primary inguinal hernia by either Lichtenstein’s technique or laparoscopy from 1998 to 2012. Within this prospectively collected cohort, the hernia type at the primary procedure (direct inguinal hernia (DIH), indirect inguinal hernia (IIH), combination hernia), the hernia type at the recurrent procedure (DIH, IIH, combination hernia, femoral hernia), anesthesia type, and time from primary procedure to reoperation were registered. RESULTS: A total of 5,893 females with primary elective inguinal hernia operation on in the study period (61 % IIH, 37 % DIH, 2 % combined hernias) were included with a median follow-up time of 72 months (range 0 to 169). A total of 305 operations for suspected recurrences were registered (61 % inguinal recurrences, 38 % femoral recurrences, 1 % no hernias), which corresponded to an overall reoperation rate of 5.2 %. All femoral recurrences occurred after a previous open anterior operation. The crude reoperation rate after primary DIH operation was 11.0 %, 3.0 % after primary IIH operation and 0.007 % after combined hernia operation (p < 0.001). The multivariate adjusted analysis found that DIH at primary operation was a substantial risk factor for recurrence with a hazard ratio of 3.1 (CI 95 % 2.4–3.9) compared with IIH at primary operation (p < 0.001), and that laparoscopic operation gave a lower risk of recurrence with a hazard ratio of 0.57 (CI 95 % 0.43–0.75) compared with Lichtenstein’s technique (p < 0.001). The risk of femoral recurrence was correlated to operation for DIH with a hazard ratio of 2.4 (CI 95 % 1.7–3.5) compared with operation for IIH. CONCLUSION: In a female nationwide prospectively gathered cohort, we found that operation for a DIH resulted in a higher risk of reoperation than operation for an IIH. We found that femoral hernia recurrences exclusively existed after anterior open primary operation. SN - 1435-2451 UR - https://www.unboundmedicine.com/medline/citation/24077676/Direct_inguinal_hernias_and_anterior_surgical_approach_are_risk_factors_for_female_inguinal_hernia_recurrences_ L2 - https://dx.doi.org/10.1007/s00423-013-1124-z DB - PRIME DP - Unbound Medicine ER -