Inguinal hernia repair in patients under and over 65 years of age: a district general hospital experience

The aim of this study is to compare outcomes of laparoscopic and open hernias in the over and under 65s at a district general hospital.

Data were collected retrospectively on patients who underwent a unilateral inguinal hernia repair from 2012 to 2016. Only open mesh Lichtenstein repairs and laparoscopic transabdominal pre-peritoneal (TAPP) mesh inguinal hernia repairs were included. The dataset included patients' demographics and comorbidities, type of surgery (open vs. laparoscopic), presentation (elective vs. emergency), length of stay and postoperative complications.

255 patients comprised the study cohort. 126 (49%) patients were under 65 years and 129 (51%) were over 65. Laparoscopic surgery was performed in 149 patients (58%), while open technique was used in 106 (42%). A higher proportion of patients over 65 underwent open surgery compared to patients under 65 (55% vs. 28%, p ≥ 0.001). Patients over 65 had a higher ASA score (p = 0.0158) and more comorbidities (COPD, DM, Anticoagulation) when compared to younger patients. The number of postop complications were 13 (10%) in the over 65s compared to 14 (11%) in the under 65s (p = 0.94). There was no statistical difference in length of stay between the over and under 65 patients (p = 0.06).

Despite more comorbidities in the over 65s, this study shows that there is no significant difference in complication rates between laparoscopic and open inguinal hernia repair irrespective of age category. Selection bias for the type of repair and the potential for an alpha error mean larger studies are required to show equivalence.