Fewer hernia recurrences in women after laparoscopic repair

Last Updated: 2018-11-07

By Anne Harding

NEW YORK (Reuters Health) - Recurrence of inguinal hernia in women is less likely to occur with laparoscopic repair than with open repair, according to a new systematic review.

"Furthermore, 40.9% of the recurrences after open repair were femoral hernias," Line Schmidt of Herlev Hospital in Herlev, Denmark, the study's first author, told Reuters Health by email. "In addition to that, the review also shows that there are very few studies that specify recurrence rates after inguinal hernia repair for women."

Women have a 3% lifetime chance of developing inguinal hernia, compared to 27% for men, Schmidt and her colleagues note in JAMA Surgery, online October 31. No randomized controlled trials or reviews have specifically investigated inguinal hernia repair in women, they add.

The authors reviewed 55 studies including more than 43,000 women, consisting of five randomized controlled trials, 14 prospective cohort studies, seven prospective database studies and 29 retrospective cohort studies.

Among 20 studies reporting on laparoscopic repair, crude recurrence was 1.2% over a median follow-up of 24 months, while 37 studies of open repair found crude recurrence of 2.4% over 36 months of follow-up.

When the authors limited their analysis to randomized clinical trials and prospective studies, recurrence rates were 1.2% with laparoscopic repair and 4.9% with open repair. None of the patients who underwent laparoscopic repair had a recurrent femoral hernia, versus 40.9% of those who had open repair.

Femoral hernias are less likely to be overlooked during laparoscopic surgery, Schmidt noted. "In laparoscopic surgery, the surgeon has a clear view of both inguinal and femoral orifices which is not the case in open anterior surgery. Furthermore, in laparoscopic surgery a mesh is placed that covers both inguinal and femoral orifices meaning that both hernia types are repaired during the same operation."

Open repair is recommended for patients who have already had laparoscopic repair, Schmidt noted, as well as for patients who are not candidates for general anesthesia. She added that "the laparoscopic technique requires experience and if the right expertise is not available, an open approach would be more appropriate."

Future research should include better studies of post-repair outcomes in women, Schmidt said. "The laparoscopic method is recommended in international guidelines as the method of choice in women with primary inguinal hernias. However, there are no studies yet that specifically address postoperative complications in women. It is difficult to perform randomized clinical trials due to the low number of female patients with inguinal hernias but large nationwide databases and registries may be a way to address the area."

SOURCE: https://bit.ly/2OuX2Rb

JAMA Surg 2018.