Predictors of laparoscopic versus open inguinal hernia repair

Comparison of Robotic, Laparoscopic, and Open Unilateral Repair of Non-recurrent Inguinal Hernia

BACKGROUND

There is a paucity of data comparing open, robotic, and laparoscopic approaches on unilateral, non-recurrent inguinal hernias. Our study presents a large, retrospective triple-arm outcome analysis between robotic, laparoscopic, and open unilateral, non-recurrent inguinal hernia repairs at a single institution.

METHODS

706 patients who underwent elective, non-recurrent inguinal hernia repair performed by 8 general surgeons at a single institution from 2016 to 2019 were reviewed retrospectively. Patient baseline characteristics, operative times, resident involvement, and postoperative outcomes were analyzed for all repair types. A cost analysis of the different procedures was performed.

RESULTS

There were 305 laparoscopic repairs, 207 robotic repairs, and 194 open repairs. Open and laparoscopic repairs were performed on patients who were older (p =< .001) and with a higher Charlson Comorbidity Index (p =< .001). Patient BMI was higher in minimally invasive repair than open repair (P = .021). There were no significant differences in complication rates on pairwise analysis. Robotic and open repairs had significantly longer operative times than laparoscopic repairs (P < .001). There was less resident involvement in robotic repair than with the other approaches (P < .001). Resident involvement was associated with shorter OR times (P = .001) and no significant difference in postoperative complications. There was a trend over the study period toward faster operative times and more robotic repair. Robotic repair is the most expensive repair, followed by laparoscopic and open repairs.

CONCLUSION

All 3 repair techniques can be performed without significant differences in outcomes. The technique utilized should be based on surgeon preference and patient characteristics.

Comparison of laparoscopic and open inguinal hernia repair in adults: A retrospective cohort study using a medical claims database

INTRODUCTION

This study aimed to investigate and compare the surgical complications following laparoscopic inguinal hernia repair (LIHR) with those following open inguinal hernia repair (OIHR).

METHODS

This was a retrospective cohort study based on nationwide claims data. We extracted the data of patients aged ≥20 years who underwent inguinal hernia repair (IHR) between 2009 and 2020. The primary outcome was postoperative complications of IHR, and the secondary outcomes were recurrence of hernia and length of hospital stay. Patient characteristics were adjusted with propensity score (PS) matching, the annual proportions of LIHR versus OIHR were summarized, and the surgical outcomes of each IHR were analyzed.

RESULTS

Of the 15 728 eligible patients, 6512 underwent LIHR. The proportion of LIHR increased from 14.7% to 52.8% annually during the study period. From the analysis of 6060 pairs created by PS matching, the risk of surgical site infection (odds ratio [OR] 0.70; 95% confidence interval [CI] 0.56-0.86; P = .0007), and acute postoperative pain (OR 0.69; 95% CI 0.60-0.79; P < .0001), and chronic postoperative pain (OR 0.83; 95% CI 0.70-0.98; P = .0291) were significantly lower with LIHR than with OIHR. The recurrent rate was not significantly different between the LIHR and OIHR groups (OR, 0.68; 95% CI 0.45-1.01; P = .0558). Furthermore, no significant difference was found in the length of hospital stay between the LIHR and OIHR groups (2.91 ± 1.94 days vs 2.97 ± 2.61 days, difference ± SE: 0.06 ± 0.04, P = .1307).

CONCLUSION

LIHR might be superior to OIHR in terms of fewer surgical complications and might be preferred over OIHR in the future.

[Demographic perspective on the concept of the tailored approach in surgery : Analysis of the quality of life exemplified by inguinal hernia repair]

INTRODUCTION

The constant increase in life expectancy for over 170 years is one of the biggest achievements of modern society. In Germany the probability of an 80-year-old person becoming 100 years old has increased by a factor of 20 since the 1950s. This fact has various implications for the clinical routine and therapeutic guidelines. In addition to the quantitative factors (e.g. complications, recurrence rate), the quality of life (QoL) as a patient-centered subjective factor should be taken into consideration in the treatment options for hernia repair. To compare heterogeneous cohorts of patients regarding the QoL, a standardization based on representative reference values is absolutely essential.

MATERIAL AND METHODS

The study was based on data from the follow-up of 310 patients who underwent inguinal hernia repair at the surgery department of the University Hospital Rostock. The preoperative clinical examination of the patients and a questionnaire were supplemented by a postal follow-up survey postoperatively at a median of 20 months (follow-up rate 66%). Patient pain level was assessed by a visual analogue scale (VAS) and health-unspecific QoL by the EQ-5D questionnaire. Standardization of the EQ-5D was based on a survey on a normative German reference population.

RESULTS

Analysis of the patients in the various treatment arms showed significant differences in age composition and health states (American Society of Anesthesologists, ASA scores) of the patient cohorts. A comparison of the QoL between the two mesh-based procedures, the transabdominal preperitoneal (TAPP) procedure and the Lichtenstein procedure, showed that complete recovery is possible after 6 months. A slight decrease in the QoL of the Lichtenstein cohort patients was ascertainable, which can be explained by the method and the higher age of the group. Taking the differences in age of the two groups into account led to a change of the QoL outcome.

CONCLUSION

The concept of QoL is currently becoming increasingly more important in the assessment of treatment procedures. When comparing several therapeutic procedures, a standardization must be undertaken to take the heterogeneity of patient cohorts into consideration. Analogous to the relative survival in cancer epidemiology, the measured QoL scores should be put in the relationship to the age and sex-specific reference of the general population in order to demonstrate the actual effect of the disease in question and its treatment.