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.

Improved patient-reported outcomes after open preperitoneal inguinal hernia repair compared to anterior Lichtenstein repair: 10-year ACHQC analysis

“…Increasing attention has been directed at assessing QoL after hernia repair in addition to more traditional outcomes like complications, including recurrence and chronic pain. In our recent study comparing TREPP to MIS robotic and laparoscopic approaches, potential benefit in short-term QoL was identified for those individuals undergoing open posterior approaches, potentially due to the generous use of local anesthesia and avoidance of general anesthesia [ 19 ]. In this work, we compared two open IHR approaches – TREPP versus Lichtenstein, and found that when confounding variables are accounted for, posterior mesh placement is associated with lower patient-reported postoperative pain, lower use of opioids, and clinically significant difference in return to activity without increasing postoperative complications and risk of recurrence.…”

Laparoscopic versus open inguinal hernia repair in aging patients: A propensity score matching-based retrospective study

“…However, with the development of minimally invasive surgery, the application of minimally invasive technology has bene ted much more patients. For example, the emergence of transabdominal preperitoneal prosthetic (TAPP), totally extraperitoneal repair (TEP), and the robotic TAPP (rTAPP) have diversi ed the minimally invasive surgical treatment of inguinal hernia [4,5] .…”

Laparoscopic versus Open Inguinal Hernia Repair in Aging Patients: A Propensity Score Matching-Based Retrospective Study

“…For example, the emergence of transabdominal preperitoneal prosthetic (TAPP), totally extraperitoneal repair (TEP), and the robotic TAPP (rTAPP) has diversified the minimally invasive surgical treatment of inguinal hernia. 4 , 5 …”

“…For example, the emergence of transabdominal preperitoneal prosthetic (TAPP), totally extraperitoneal repair (TEP), and the robotic TAPP (rTAPP) has diversified the minimally invasive surgical treatment of inguinal hernia. 4,5 Laparoscopic inguinal hernia repair (LIHR) and open inguinal hernia repair (OIHR) procedures are often compared during the 20 years. 4,[6][7][8][9] Importantly, with the advantages of minimally invasive technology, such as reduced wound complications, less recurrence rate, and faster recovery, which is highly favored by not only surgeons but also patients.…”