Longitudinal assessment of recurrence after open versus laparoscopic versus robotic inguinal hernia repair in 272,475...

Historic data on inguinal hernia repair recurrences have been mixed, with some reports demonstrating higher recurrences after laparoscopic (laparoscopic IHR) and robotic inguinal hernia repair (robotic IHR) as compared with open inguinal hernia repair (open IHR). We evaluated the contemporary, real-world recurrence requiring reoperation (RRR) rates among open IHR, laparoscopic IHR, and robotic IHR.

This population-based study utilized New York and Florida state databases between October 2015 and December 2021 to identify adult patients who underwent uncomplicated IHR using ICD-10 codes and categorized them into open IHR, laparoscopic IHR, or robotic IHR. RRR was defined as time to a second ipsilateral IHR.

Among 265,955 patients, 134,348 underwent open IHR, 106,425 laparoscopic IHR, and 25,182 robotic IHR. Open IHR decreased from 61.8% in 2015 to 40.0% in 2021, while laparoscopic IHR and robotic IHR increased from 36.2 and 2.0% in 2015 to 40.0 and 16.9% in 2021, respectively (all p < 0.001). In 2015, RRR rates were similar for L‑IHR and O‑IHR (1.6%) but higher for R‑IHR (3.7%); by 2021, the RRR rate after R‑IHR declined to match the others. Multilevel Cox regression analysis demonstrated that laparoscopic IHR (HR 0.5 (0.4-0.7), p < 0.001) and robotic IHR (HR 0.4 (0.2-0.9), p = 0.04) were associated with lower risk of RRR in high laparoscopic inguinal hernia case volume institutions. Older age, White race, chronic obstruction pulmonary disease, obesity, hypertension, and tobacco use were independently associated with higher RRR.

In contemporary times, RRR rates after laparoscopic IHR and open IHR were similar. While the RRR rate after robotic IHR was higher than both open IHR and laparoscopic IHR in earlier years, it has since declined to equivalent rates in recent years.