Tags

Type your tag names separated by a space and hit enter

Reoperation rates for laparoscopic vs open repair of femoral hernias in Denmark: a nationwide analysis.
JAMA Surg. 2014 Aug; 149(8):853-7.JS

Abstract

IMPORTANCE

In Denmark approximately 10 000 groin hernias are repaired annually, of which 2% to 4% are femoral hernias. Several methods for repair of femoral hernias are used including sutured repair and different types of mesh repair with either open or laparoscopic techniques. The use of many different approaches reflects a rather low level of evidence for the best method of repair. Randomized clinical trials are lacking. Large, prospective cohort studies are an alternative way of acquiring improved evidence regarding the best type of repair.

OBJECTIVE

To investigate the reoperation rate after laparoscopic vs open femoral hernia repair, analyzing data from a nationwide database.

DESIGN, SETTING, AND PARTICIPANTS

A prospective cohort study was conducted. Data on femoral hernia repairs registered in the Danish Hernia Database from January 1998 until February 2012 were extracted and analyzed. All repairs were followed in the database and analyzed for reports of reoperation, which were used as a proxy for recurrence. Femoral hernia recurrence and inguinal hernia occurrence after the index repair were analyzed.

EXPOSURE

Repair of a femoral hernia.

MAIN OUTCOMES AND MEASURES

Reoperation for a femoral hernia.

RESULTS

A total of 3970 primary femoral hernia repairs were analyzed; 27.3% occurred in men. There were 2413 elective repairs (60.8%) and 1557 emergency procedures (39.2%). In a multivariate analysis, laparoscopic repair was found to result in reduced risk of reoperation (hazard ratio, 0.33; 95% CI, 0.09-0.95) compared with open repair. The risk of reoperation was higher in women (hazard ratio, 1.95; 95% CI, 1.10-3.45). Furthermore, the laparoscopic approach seemed to reduce the risk of subsequent occurrence of an inguinal hernia in the same groin.

CONCLUSIONS AND RELEVANCE

Laparoscopic repair of a femoral hernia reduces the risk of reoperation for a recurrence compared with open repair. The results from this study support the guidelines recommending the use of the laparoscopic approach for repair of femoral hernias.

Authors+Show Affiliations

Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark2Danish Hernia Database, Copenhagen, Denmark.Danish Hernia Database, Copenhagen, Denmark3Department of Gastroenterology, Surgical Section, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.Danish Hernia Database, Copenhagen, Denmark4Section of Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.Danish Hernia Database, Copenhagen, Denmark5Department of Surgery, Aarhus University Hospital, University of Aarhus, Aarhus, Denmark.Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark2Danish Hernia Database, Copenhagen, Denmark.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

25007246

Citation

Andresen, Kristoffer, et al. "Reoperation Rates for Laparoscopic Vs Open Repair of Femoral Hernias in Denmark: a Nationwide Analysis." JAMA Surgery, vol. 149, no. 8, 2014, pp. 853-7.
Andresen K, Bisgaard T, Kehlet H, et al. Reoperation rates for laparoscopic vs open repair of femoral hernias in Denmark: a nationwide analysis. JAMA Surg. 2014;149(8):853-7.
Andresen, K., Bisgaard, T., Kehlet, H., Wara, P., & Rosenberg, J. (2014). Reoperation rates for laparoscopic vs open repair of femoral hernias in Denmark: a nationwide analysis. JAMA Surgery, 149(8), 853-7. https://doi.org/10.1001/jamasurg.2014.177
Andresen K, et al. Reoperation Rates for Laparoscopic Vs Open Repair of Femoral Hernias in Denmark: a Nationwide Analysis. JAMA Surg. 2014;149(8):853-7. PubMed PMID: 25007246.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reoperation rates for laparoscopic vs open repair of femoral hernias in Denmark: a nationwide analysis. AU - Andresen,Kristoffer, AU - Bisgaard,Thue, AU - Kehlet,Henrik, AU - Wara,Pål, AU - Rosenberg,Jacob, PY - 2014/7/10/entrez PY - 2014/7/10/pubmed PY - 2014/10/21/medline SP - 853 EP - 7 JF - JAMA surgery JO - JAMA Surg VL - 149 IS - 8 N2 - IMPORTANCE: In Denmark approximately 10 000 groin hernias are repaired annually, of which 2% to 4% are femoral hernias. Several methods for repair of femoral hernias are used including sutured repair and different types of mesh repair with either open or laparoscopic techniques. The use of many different approaches reflects a rather low level of evidence for the best method of repair. Randomized clinical trials are lacking. Large, prospective cohort studies are an alternative way of acquiring improved evidence regarding the best type of repair. OBJECTIVE: To investigate the reoperation rate after laparoscopic vs open femoral hernia repair, analyzing data from a nationwide database. DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study was conducted. Data on femoral hernia repairs registered in the Danish Hernia Database from January 1998 until February 2012 were extracted and analyzed. All repairs were followed in the database and analyzed for reports of reoperation, which were used as a proxy for recurrence. Femoral hernia recurrence and inguinal hernia occurrence after the index repair were analyzed. EXPOSURE: Repair of a femoral hernia. MAIN OUTCOMES AND MEASURES: Reoperation for a femoral hernia. RESULTS: A total of 3970 primary femoral hernia repairs were analyzed; 27.3% occurred in men. There were 2413 elective repairs (60.8%) and 1557 emergency procedures (39.2%). In a multivariate analysis, laparoscopic repair was found to result in reduced risk of reoperation (hazard ratio, 0.33; 95% CI, 0.09-0.95) compared with open repair. The risk of reoperation was higher in women (hazard ratio, 1.95; 95% CI, 1.10-3.45). Furthermore, the laparoscopic approach seemed to reduce the risk of subsequent occurrence of an inguinal hernia in the same groin. CONCLUSIONS AND RELEVANCE: Laparoscopic repair of a femoral hernia reduces the risk of reoperation for a recurrence compared with open repair. The results from this study support the guidelines recommending the use of the laparoscopic approach for repair of femoral hernias. SN - 2168-6262 UR - https://www.unboundmedicine.com/medline/citation/25007246/Reoperation_rates_for_laparoscopic_vs_open_repair_of_femoral_hernias_in_Denmark:_a_nationwide_analysis_ L2 - https://jamanetwork.com/journals/jamasurgery/fullarticle/10.1001/jamasurg.2014.177 DB - PRIME DP - Unbound Medicine ER -