Is the age of >65 years a risk factor for endoscopic treatment of primary inguinal hernia? Analysis of 24,571 patients from the Herniamed Registry

Abstract

Introduction Several analyses of hernia registries have demonstrated that patients older than 65 years have significantly higher perioperative complication rates compared with patients up to the age of 65. To date, no special analyses of endoscopic/laparoscopic inguinal hernia surgery or of the relevant additional influence factors have been carried out. Besides, there is no definition to determine whether 65 years should really be considered to be the age limit.MethodsIn the Herniamed Hernia Registry, it was possible to identify 24,571 patients with a primary inguinal hernia and aged at least 16 years who had been operated on between September 1, 2009, and April 15, 2013, using either the TAPP technique (n = 17,214) or TEP technique (n = 7,357). Patients in the age group up to and including 65 years (≤65 years) were compared with those older than 65 years (>65 years) in terms of their perioperative outcome. That was done first using unadjusted analysis and then multivariable analysis.ResultsUnadjusted analysis revealed significantly different results for the intraoperative (1.19 vs 1.60 %; p = 0,010), postoperative surgical (2.72 vs 4.59 %; p < 0.001) and postoperative general complications (0.85 vs 1.98 %; p < 0.001) as well as for complication-related reoperations (1.07 vs 1.37 %; p = 0,044), which were more favorable in the ≤65 years age group. However, in multivariable analysis, it was not possible to confirm that for the intraoperative complications or the reoperations. Reoperations were needed more often for bilateral procedures (p < 0.001; OR 2.154 [1.699; 2.730]), higher ASA classification (IV vs I: p = 0.004; OR 6.001 [1.786; 20.167]), larger hernia defect and scrotal hernias. The impact of these factors, in addition to that of age >65 years, was also reflected in the postoperative complication rates. The age limit for increased onset of perioperative complication rates tends to be more than 80 rather than 65 years.ConclusionThe higher perioperative complication rate associated with endoscopic/laparoscopic inguinal hernia surgery in patients older than 65 years is of multifactorial genesis and is observed in particular as from the age of 80 years.

Incidence of postoperative complications in transabdominal preperitoneal repair for groin hernia is influenced by poor performance status rather than by old age

“…The results suggested that patient‐reported outcomes may be better in LHS than in OHS, regardless of a greater risk of minor postoperative complications such as seroma and urinary retention in elderly patients compared with non‐elderly patients. Mayer et al also showed that the rate of perioperative complications in LHS tends to increase with age, in particular from the age of 80 years . However, to our knowledge, no studies have compared the outcomes of TAPP repair between elderly and non‐elderly patients in consecutive cases of groin hernia.…”

“…This can lead to the occurrence of perioperative complications and delay the return to daily life. Generally, the risk assessment of LHS was based on patient's age, underlying diseases, type of hernia, size of hernia orifice, ASA class etc; however, no studies investigated the association between patient's PS and the incidence of perioperative complications. This study for the first time showed that poor PS is an independent predictive factor of perioperative complications after TAPP.…”

“…Because the incidence of groin hernia is higher in the elderly than in younger individuals due to the weakening of tissue with age, the number of groin hernia surgeries for elderly patients is expected to increase as the population progressively ages in developed countries. Furthermore, postoperative morbidity and mortality rates in major surgery are also higher in elderly patients than in young patients .…”

The reality of general surgery training and increased complexity of abdominal wall hernia surgery

“…Examining endoscopic inguinal hernia surgery the rate of perioperative complications increases in octogenarians and above [48]. In the Spanish National Registry of Incisional Hernia (EVEREG) increasing incisional hernia complication rates was observed from age > 70 years [49].…”

A comparative study between open lichtenstein mesh repair and laparoscopic totally extra peritoneal repair of inguinal hernia

“…The reliable data from Asia and the United States are still deficient. 9 Thus, this background indicates that there is a paucity of data with respect to the endoscopic repairs is concerned in addition to the lack of data on comparing and contrasting both techniques especially in the low resource settings like India. Detailed clinical history was taken from patients as per the proforma.…”