Recurrence Rates After Repair of Inguinal Hernia in Women

Abstract

ach year, more than 20 million procedures to repair inguinal hernia are performed worldwide. 1 The lifetime risk of developing an inguinal hernia is 27% for men compared with only 3% for women. 2 However, studies have reported that 8% to 16% of patients with inguinal hernia are females. 3,4 Nevertheless, to our knowledge, no randomized controlled trial (RCT) or systematic review has specifically addressed repair of groin hernia in women. 5 Guidelines for repair of inguinal hernias in women are based mainly on subgroup analyses of national database studies in which most patients were men. [5][6][7] Differences regarding pelvic and inguinal anatomy between men and women 8 could mean that the recurrence rate of inguinal hernias may differ, and recurrences after repair of inguinal hernia in women may be a previously undiagnosed femoral hernia. 9,10 Therefore, the rate and type of recurrence for in-guinal hernias needs to be assessed specifically in women. This study investigates rates and types of recurrences in women who underwent repair of a primary inguinal hernia. MethodsThis study was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guideline. 11 A detailed protocol was registered at the PROSPERO systematic review registration site (registration CRD42017081152). 12 Participants in the study were women age 18 years or older who had undergone repair of a primary unilateral or bilateral inguinal hernia. Studies including participants with solely recurrent inguinal hernias or solely femor-IMPORTANCE To our knowledge, a systematic review has not yet been performed that specifically addresses the management of inguinal hernia in women. Recurrence after repair of inguinal hernia is not unusual in women and may be a previously undiagnosed femoral hernia, which is rarely seen in men. OBJECTIVE To investigate rates and types of recurrences in women who had undergone repair of primary inguinal hernia.EVIDENCE REVIEW PubMed, Embase, and the Cochrane databases were searched in September 2017 for studies reporting recurrences after repair of primary inguinal hernia in women. Crude rates of recurrence (number of recurrences/number of women) were calculated after open and laparoscopic repairs, and the type of recurrent hernia was registered, if noted in the studies. This review is reported according to the PRISMA guideline. FINDINGS A total of 55 studies were included, comprising 43 870 women (mean age, 42-69 years; median age, 57 years). Five studies were randomized clinical trials, 14 were prospective cohort studies, 7 were prospective database studies, and 29 were retrospective cohort studies. Twenty studies reported recurrence after laparoscopic repair, with a crude recurrence rate of 1.2% (27 of 2257) (range, 0%-5%) and a median follow-up of 24 months. Thirty-seven studies reported open repair, with a crude recurrence rate of 2.4% (818 of 33 971) (range, 0%-12.5%) and a median follow-up of 36 months. The crude recurrence rate in randomized clinical trials and prospectiv...

Femoral Hernia: Uncommon, but Associated With Potentially Severe Complications

“…Four of our female patients were subjected to previous inguinal herniorrhaphies in other institutions. Although some authors have suggested that prior inguinal hernia repair might be a risk factor for femoral hernia development, most believe that this association is inaccurate 29 . The occurrence of femoral hernia after inguinal herniorrhaphy is possibly due to unrecognized femoral hernia during the first operation and not a new hernia.…”

“…In a systematic review of recurrence after inguinal hernia repair in females, Schmidt et al 29 reported that 203 of 496 patients (40.9%) with recurrent hernia had femoral hernia after open procedure compared with no recurrence after laparoscopic repair. These findings suggested that the high development of femoral hernia after inguinal herniorrhaphy was due to non-identification of femoral hernia in the initial operation because of its deep location and small size.…”

What is the outcome of re-recurrent vs recurrent inguinal hernia repairs? An analysis of 16,206 patients from the Herniamed Registry

“…Nevertheless, to date, there are no comparable findings for these data in the literature. Only the proportion of re-recurrences of around 8% is also seen in the Danish Hernia Database [ 11 ]. The data impressively demonstrate just how demanding is inguinal hernia surgery for recurrences and re-recurrences.…”

“…In recent administrative data and registry analyses it was revealed that the proportion of recurrent repairs in the total collective of inguinal hernia repairs among men was 11.3–14.3% [ 3 – 7 ] and in women 7.0–7.4% [ 4 , 8 ]. By contrast, in systematic reviews and meta-analyses the recurrence rates were still far lower (1.2–3%) than those cited above since the included studies had a maximum follow-up time of 6 years [ 9 – 11 ].…”

Hernia and Cancer: The Points Where the Roads Intersect

“…Primary hernias may be congenital or acquired (8–11). Unlike cancers, hernias are benign conditions and cure without recurrence is possible in almost 95% of cases, especially for groin hernias (12, 13), although the recurrence rates are higher for ventral hernias (14–16). Morbidity is also very low and the mortality rate is almost zero after hernia repairs except for emergency repairs, especially in the elderly (17–20).…”