Reoperation for inguinal hernia recurrence in Ontario: a population-based study

Area of Science:

• Surgical outcomes research
• Comparative effectiveness studies
• Hernia repair techniques

Background:

• Inguinal hernia repair (IHR) is a common surgical procedure.
• The comparative effectiveness of laparoscopic versus open IHR in real-world settings is not well-established.
• Understanding recurrence rates is crucial for patient outcomes.

Purpose of the Study:

• To compare the rate of recurrent inguinal hernia after laparoscopic versus open mesh repair.
• To evaluate the impact of surgeon caseload on recurrence rates for different IHR techniques.

Main Methods:

• Population-based retrospective cohort study using linked administrative databases in Ontario, Canada.
• Inclusion of adult patients undergoing primary IHR between 2003 and 2012, with follow-up until 2014.
• Primary outcome: reoperation for recurrent IHR, analyzed using Cox proportional hazards modeling, with adjustments for patient and surgeon factors.

Main Results:

• A total of 93,501 primary IHRs were analyzed (85.4% open, 14.6% laparoscopic).
• The 5-year cumulative risk of recurrence was 2.0% for open repair and 3.4% for laparoscopic repair.
• Laparoscopic repair was associated with a higher recurrence risk for surgeons with ≤50 cases/year (HR 1.76-1.78), but not for those with >50 cases/year (HR 1.21).

Conclusions:

• Laparoscopic inguinal hernia repair (IHR) is generally linked to a higher recurrence risk compared to open IHR.
• High-volume surgeons performing laparoscopic IHR may achieve comparable results to open repair.
• Few surgeons in the study met the high-volume criterion (>50 cases/year) for laparoscopic repairs, suggesting potential challenges in achieving optimal outcomes.