Long-term recurrence after inguinal hernia repair in a single-surgeon cohort using predefined mesh per approach

BACKGROUND: We aimed to evaluate, within a single-surgeon, predefined, approach-specific mesh protocol, whether the surgical approach (laparoscopic vs. open) is independently associated with long-term recurrence after adjusting for patient-related factors. PATIENTS AND METHODS: A total of 314 patients who underwent surgery using both laparoscopic and open techniques between 2013 and 2022 by a single expert general surgeon were analyzed. The patients’ age, gender, hernia side, body mass index (BMI), comorbidities, preoperative American Society of Anesthesiologists scores, type of operation, postoperative complications, and recurrence rates during follow-up were retrospectively reviewed from the Electronic Patient File (EPF) system. Repairs followed a predefined, approach-specific mesh protocol (self-gripping mesh for open repairs; pre-formed polypropylene mesh for laparoscopic repairs). RESULTS: The median follow-up duration was 72 months (IQR 56.5–102; range 26–140 months). Overall recurrence was observed in 24 of 314 patients (7.6%) during follow-up. Crude rates were similar between approaches (7.3% after open [14/192] vs. after laparoscopic 8.2% [10/122], p = 0.769). In multivariable analysis, diabetes mellitus, cardiovascular disease, and prior repair emerged as independent predictors of recurrence. CONCLUSION: In a standardized setting minimizing surgeon and implant heterogeneity, recurrence was approximately 8% at a median follow-up of about 6 years and was primarily associated with patient-related factors, such as comorbidity and prior repair, rather than surgical approach. Within the context of this cohort, these findings should be interpreted as hypothesis-generating and may reflect recurrence patterns observed under standardized conditions, rather than a definitive lower-bound benchmark. They also highlight the potential relevance of pre- and perioperative risk optimization beyond surgical approach selection alone.