Ferdinand Köckerling1, Ralph Lorenz2, Martin Hukauf3, Henning Grau4, Dietmar Jacob5, René Fortelny6, Andreas Koch7. 1. Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Berlin, Germany. 2. Hernia Center 3+CHIRURGEN, Klosterstrasse 34/35, Berlin, Germany. 3. StatConsult GmbH, Halberstädter Strasse 40 a, Magdeburg, Germany. 4. Health Center Gropiusstadt, Orthopedic-Surgical-Practice g-g-h-z, Lipschitzallee, Berlin, Germany. 5. Orthopedic-Surgical-Practice, Kaiser-Wilhelm-Strasse 24-26, Berlin, Germany. 6. Department of General Surgery, Wilhelminenhospital, Sigmund Freud University, Medical Faculty, Montleartstrasse 37, Vienna, Austria. 7. Hernia Center Cottbus, Gerhard-Hauptmann-Strasse 15, Cottbus, Germany.
Abstract
OBJECTIVE: Based on an analysis of data from the Herniamed Registry, this study aims to identify all factors influencing the outcome in female groin hernia repair. BACKGROUND: In a systematic review and meta-analysis of observational studies, female sex was found to be a significant risk factor for recurrence. In the guidelines, the totally extraperitoneal patch plasty (TEP) and transabdominal preperitoneal patch plasty (TAPP) laparo-endoscopic techniques are recommended for female groin hernia repair. However, even when complying with the guidelines, a less favorable outcome must be expected than in men. To date, there is no study in the literature for analysis of all factors influencing the outcome in female groin hernia repair. METHODS: In all, 15,601 female patients from the Herniamed Registry who had undergone primary unilateral groin hernia repair with the Lichtenstein, Shouldice, TEP or TAPP technique, and for whom 1-year follow-up was available, were selected between September 1, 2009 and July 1, 2017. Using multivariable analyses, influencing factors on the various outcome parameters were identified. RESULTS: In the multivariable analysis, a significantly higher risk of postoperative complications, complication-related reoperations, recurrences, and pain on exertion was found only for the Lichtenstein technique. No negative influence on the outcome was identified for the TEP, TAPP, or Shouldice techniques. Relevant risk factors for occurrence of perioperative complications, recurrences, and chronic pain were preoperative pain, existing risk factors, larger defects, a higher body mass index (BMI), higher American Society of Anesthesiologists (ASA) classification and postoperative complications. Higher age had a negative association with postoperative complications and positive association with pain rates. CONCLUSIONS: Female groin hernia repair should be performed with the TEP or TAPP laparo-endoscopic technique, or, alternatively, with the Shouldice technique, if there is no evidence of a femoral hernia. By contrast, the Lichtenstein technique has disadvantages in terms of postoperative complications, recurrences, and pain on exertion. Important risk factors for an unfavorable outcome are preoperative pain, existing risk factors, higher ASA classification, higher BMI, and postoperative complications. A higher age and larger defects have an unfavorable impact on postoperative complications and a more favorable impact on chronic pain.
OBJECTIVE: Based on an analysis of data from the Herniamed Registry, this study aims to identify all factors influencing the outcome in female groin hernia repair. BACKGROUND: In a systematic review and meta-analysis of observational studies, female sex was found to be a significant risk factor for recurrence. In the guidelines, the totally extraperitoneal patch plasty (TEP) and transabdominal preperitoneal patch plasty (TAPP) laparo-endoscopic techniques are recommended for female groin hernia repair. However, even when complying with the guidelines, a less favorable outcome must be expected than in men. To date, there is no study in the literature for analysis of all factors influencing the outcome in female groin hernia repair. METHODS: In all, 15,601 female patients from the Herniamed Registry who had undergone primary unilateral groin hernia repair with the Lichtenstein, Shouldice, TEP or TAPP technique, and for whom 1-year follow-up was available, were selected between September 1, 2009 and July 1, 2017. Using multivariable analyses, influencing factors on the various outcome parameters were identified. RESULTS: In the multivariable analysis, a significantly higher risk of postoperative complications, complication-related reoperations, recurrences, and pain on exertion was found only for the Lichtenstein technique. No negative influence on the outcome was identified for the TEP, TAPP, or Shouldice techniques. Relevant risk factors for occurrence of perioperative complications, recurrences, and chronic pain were preoperative pain, existing risk factors, larger defects, a higher body mass index (BMI), higher American Society of Anesthesiologists (ASA) classification and postoperative complications. Higher age had a negative association with postoperative complications and positive association with pain rates. CONCLUSIONS: Female groin hernia repair should be performed with the TEP or TAPP laparo-endoscopic technique, or, alternatively, with the Shouldice technique, if there is no evidence of a femoral hernia. By contrast, the Lichtenstein technique has disadvantages in terms of postoperative complications, recurrences, and pain on exertion. Important risk factors for an unfavorable outcome are preoperative pain, existing risk factors, higher ASA classification, higher BMI, and postoperative complications. A higher age and larger defects have an unfavorable impact on postoperative complications and a more favorable impact on chronic pain.
Authors: R Lorenz; G Arlt; J Conze; R Fortelny; J Gorjanc; A Koch; J Morrison; V Oprea; G Campanelli Journal: Hernia Date: 2021-01-27 Impact factor: 4.739
Authors: Sara M Jafri; C Ann Vitous; Lesly A Dossett; Claire Seven; Michael J Englesbe; Anne Sales; Dana A Telem Journal: JAMA Surg Date: 2020-06-01 Impact factor: 14.766
Authors: M Maneck; F Köckerling; C Fahlenbrach; C D Heidecke; G Heller; H J Meyer; U Rolle; E Schuler; B Waibel; E Jeschke; C Günster Journal: Hernia Date: 2019-11-30 Impact factor: 4.739
Authors: F Köckerling; C Krüger; I Gagarkin; A Kuthe; D Adolf; B Stechemesser; H Niebuhr; D Jacob; H Riediger Journal: Hernia Date: 2020-02-21 Impact factor: 4.739
Authors: F Köckerling; A J Sheen; F Berrevoet; G Campanelli; D Cuccurullo; R Fortelny; H Friis-Andersen; J F Gillion; J Gorjanc; D Kopelman; M Lopez-Cano; S Morales-Conde; J Österberg; W Reinpold; R K J Simmermacher; M Smietanski; D Weyhe; M P Simons Journal: Hernia Date: 2019-11-21 Impact factor: 4.739