Posterior mesh inguinal hernia repairs: a propensity score matched analysis of laparoscopic and robotic versus open approaches
- PMID: 36125632
- PMCID: PMC9931785
- DOI: 10.1007/s10029-022-02680-0
Posterior mesh inguinal hernia repairs: a propensity score matched analysis of laparoscopic and robotic versus open approaches
Abstract
Purpose: International guidelines suggest the use of lapro-endoscopic technique for primary unilateral inguinal hernia (IHR) because of lower postoperative pain and reduction in chronic pain. It is unclear if the primary benefit is due to the minimally invasive approach, the posterior mesh position or both. Further research evaluating posterior mesh placement using open preperitoneal techniques is recommended. A potential benefit of open preperitoneal repair is the avoidance of general anesthesia, as these repairs can be performed under local anesthesia. This study compares clinical and patient-reported outcomes after unilateral laparo-endoscopic, robotic, and open posterior mesh IHRs.
Methods: We performed a propensity score matched analysis of patients undergoing IHR between 2012 and 2021 in the Abdominal Core Health Quality Collaborative registry. 10,409 patients underwent a unilateral IHR via a posterior approach. Hernia repairs were performed via minimally invasive surgery (MIS) which includes laparoscopic and robotic transabdominal preperitoneal (TAPP), laparoscopic totally extraperitoneal (TEP), or open transrectus preperitoneal/open preperitoneal (TREPP/OPP) approaches. Propensity score matching (PSM) utilizing nearest neighbor matching accounted for differences in baseline characteristics and possible confounding variables between groups. We matched 816 patients in the MIS cohort with 816 patients in the TREPP/OPP group. Outcomes included patient reported quality of life, hernia recurrence, and postoperative opioid use.
Results: Improvement was seen after TREPP/OPP as compared to MIS IHR in EuraHS at 30 days (Median(IQR) 7.0 (2.0-16.64) vs 10 (2.0-24.0); OR 0.69 [0.55-0.85]; p = 0.001) and 6 months (1.0 (0.0-4.0) vs 2.0 (0.0-4.0); OR 0.63 [0.46-85]; p = 0.002), patient-reported opioid use at 30-day follow-up (18% vs 45% OR 0.26 [0.19-0.35]; p < 0.001), and rates of surgical site occurrences (0.8% vs 4.9% OR 0.16 [0.06-0.35]; p < 0.001). There were no differences in EuraHS scores and recurrences at 1 year.
Conclusions: This study demonstrates a potential benefit of open posterior mesh placement over MIS repair in short-term quality of life and seroma formation with equivalent rates of hernia recurrence. Further study is needed to better understand these differences and determine the reproducibility of these findings outside of high-volume specialty centers.
Keywords: MIS inguinal hernia repair; OPP; Open preperitoneal inguinal hernia repair; Posterior mesh inguinal hernia repair; TREPP.
© 2022. The Author(s).
Conflict of interest statement
Michael Reinhorn, MD, MBA, has received consulting fees from Heron Therapeutics. Nora Fullington, MD, has no conflicts or disclosures. Divyansh Agarwal, MD, PhD, has no conflicts or disclosures. Molly A. Olson, MS, has no conflicts or disclosures. Lauren Ott PA-C has no conflicts or disclosures. Anna Canavan PA-C has no conflicts or disclosures. Bailey Pate has no conflicts or disclosures. Melissa Hubertus has no conflicts or disclosures. Alexandra Urquiza has no conflicts or disclosures. Benjamin Poulose, MD, MPH, has received research support from BD International and Advanced Medical Support; Consulting—Ethicon; he receives salary from the Abdominal Core Health Quality Collaborative (ACHQC) as the Director of Quality and Outcomes. Jeremy Warren, MD, has received fees from Intuitive Surgical as clinical proctor and speaker.
Figures
![Fig. 1](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/9931785/bin/10029_2022_2680_Fig1_HTML.gif)
![Fig. 2](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/9931785/bin/10029_2022_2680_Fig2_HTML.gif)
![Fig. 3](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/9931785/bin/10029_2022_2680_Fig3_HTML.gif)
Similar articles
-
Open preperitoneal inguinal hernia repair has superior 1-year patient-reported outcomes compared to Shouldice non-mesh repair.Hernia. 2024 Apr;28(2):475-484. doi: 10.1007/s10029-023-02936-3. Epub 2023 Dec 23. Hernia. 2024. PMID: 38142262
-
Transabdominal pre-peritoneal (TAPP) versus totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair.Cochrane Database Syst Rev. 2024 Jul 4;7(7):CD004703. doi: 10.1002/14651858.CD004703.pub3. Cochrane Database Syst Rev. 2024. PMID: 38963034 Review.
-
Current trends and outcomes for unilateral groin hernia repairs in the United States using the Abdominal Core Health Quality Collaborative database: A multicenter propensity score matching analysis of 30-day and 1-year outcomes.Surgery. 2024 Apr;175(4):1071-1080. doi: 10.1016/j.surg.2023.11.033. Epub 2024 Jan 12. Surgery. 2024. PMID: 38218685
-
Improved patient-reported outcomes after open preperitoneal inguinal hernia repair compared to anterior Lichtenstein repair: 10-year ACHQC analysis.Hernia. 2023 Oct;27(5):1139-1154. doi: 10.1007/s10029-023-02852-6. Epub 2023 Aug 8. Hernia. 2023. PMID: 37553502 Free PMC article.
-
The clinical effectiveness and cost-effectiveness of open mesh repairs in adults presenting with a clinically diagnosed primary unilateral inguinal hernia who are operated in an elective setting: systematic review and economic evaluation.Health Technol Assess. 2015 Nov;19(92):1-142. doi: 10.3310/hta19920. Health Technol Assess. 2015. PMID: 26556776 Free PMC article. Review.
Cited by
-
Learning and implementation of TransREctus sheath PrePeritoneal procedure for inguinal hernia repair.Hernia. 2024 May 17. doi: 10.1007/s10029-024-03031-x. Online ahead of print. Hernia. 2024. PMID: 38760626
-
Open vs. robot-assisted preperitoneal inguinal hernia repair. Are they truly clinically different?Hernia. 2024 May 4. doi: 10.1007/s10029-024-03050-8. Online ahead of print. Hernia. 2024. PMID: 38704470
-
Incidence and predictors of chronic pain after inguinal hernia surgery: a systematic review and meta-analysis.Hernia. 2024 Mar 27. doi: 10.1007/s10029-024-02980-7. Online ahead of print. Hernia. 2024. PMID: 38538812 Review.
-
Open preperitoneal inguinal hernia repair has superior 1-year patient-reported outcomes compared to Shouldice non-mesh repair.Hernia. 2024 Apr;28(2):475-484. doi: 10.1007/s10029-023-02936-3. Epub 2023 Dec 23. Hernia. 2024. PMID: 38142262
-
Laparoscopic versus Open Inguinal Hernia Repair in Aging Patients: A Propensity Score Matching-Based Retrospective Study.Ther Clin Risk Manag. 2023 Aug 8;19:657-666. doi: 10.2147/TCRM.S423307. eCollection 2023. Ther Clin Risk Manag. 2023. PMID: 37575687 Free PMC article.
References
-
- Lange JF, Lange MM, Voropai DA, van Tilburg MW, Pierie JP, Ploeg RJ, et al. Trans rectus sheath extra-peritoneal procedure (TREPP) for inguinal hernia: the first 1000 patients. World J Surg. 2014;38(8):1922–1928. - PubMed
-
- Faessen JL, Stoot JHMB, van Vugt R (2021) Safety and efficacy in inguinal hernia repair: a retrospective study comparing TREPP, TEP and Lichtenstein (SETTLE). Hernia 10.1007/s10029-020-02361-w - PubMed
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Miscellaneous