The history of open inguinal hernia repair

Abstract Aim Prospective evaluation comparing outcomes between laparoscopic (LIHR), robotic (RIHR), and open inguinal hernia repair (OIHR). Material and Methods Prospective institutional data comparison of patients undergoing inguinal hernia repair from 1999–2020 was performed. Patients with chronic pain or infection were excluded. Standard statistical methods were used and univariate analysis was performed between LIHR, RIHR, and OIHR groups. Results 3,300 repairs were performed: 1,970 LIHR (597-bilateral), 127 RIHR (25-bilateral), and 538 OIHR (43-bilateral). LIHR and RIHR patients were younger (55.4±14.8vs59.0±13.7vs 65.0±13.7years;p<0.01), with lower BMI (26.6±6.5vs28.9±20.3vs31.8±7.6kg/m2; p<0.01), fewer overall (2.7±1.9 vs 2.7±2.2vs3.7±2.5; p < 0.01) and cardiac (0.2% vs 0% vs 2.6%; p<0.01) comorbidities, and fewer patients had diabetes (5.2%vs4.6%vs10.9%; p<0.01). OIHR had the highest rate of recurrent hernias (21.2%vs11.2%vs30.9%; p<0.01). History of smoking was less in LIHR (13.9%vs30.9%vs19.5%%; p<0.01). Mesh was used in 99.5% of cases; synthetic was used in all minimally invasive cases and 98.4% of OIHR, with biologic mesh in 1.0% of OIHR due to bowel resection during the operation. Operative time was shortest in LIHR followed by open (86.5±39.6vs109.0±56.8vs92.6±55.2 min; p<0.01). Wound complications were more frequent in OIHR (0.8%vs0.7%vs3.8%; p<0.01). Admission was more common after open repair (2.2%vs2.7%vs5.7%; p<0.01) with a trend to less readmission following LIHR (1.0%vs2.0%vs2.3%; p=0.06). There were few recurrences overall (0.7%vs0.7%vs1.3%; p=0.40) with mean follow-up time 21.1±22.4 months. Conclusions LIHR, RIHR, and OIHR were performed with low overall morbidity and complications. Recurrent hernias and cardiac patients were most often repaired open, which more frequent admission and had higher wound morbidity. RIHR had longer OR times with no improvement overall outcomes.

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864 Adherence to British Hernia Society Standards in Consenting Practice for Inguinal Hernia Repair

British Journal of Surgery ◽

10.1093/bjs/znab259.580 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

C Binnie ◽

J Adedeji ◽

K Noureldin ◽

A Shamsiddonva

Keyword(s):

Chronic Pain ◽

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Wound Dehiscence ◽

History Of ◽

Open Inguinal Hernia Repair ◽

One Year ◽

Complications Rate

Abstract Objectives Evaluation of adherence to BHS Standards in IHRs Consent. Primary goal was the documentation of “Mesh” on clinic letter and consent form. Secondary points were the enlisted postoperative complications and advice given to reduce the risk of complications. Introduction Mesh repair is the gold standard for elective inguinal hernias. Recurrence rate is 1-3%. Chronic pain, for different causes, is documented in 10-15% (Most frequent complication). Method Retrospective study looked at first 100 patients, who were subjected to open inguinal hernia repair, in one year time. Patients under 18 years, history of previous repair and laparoscopic repair were excluded. The sample was reduced to 94, as 6 cases had untraceable and insufficient records Results Despite using mesh in all patients, it was not written in 11.7% of the consent forms and half of the clinic letters. Postoperative readmissions were 6.4% ,8.5% and 1.1% at week, month and year, respectively. The main causes were pain (1%), wound dehiscence (1%), hematoma (2%), and recurrence (1%). Overall complications rate after one year was 5.5%. Although recurrence and chronic pain are linked to hernia repair, they were not mentioned in 10% and 15%. In contrast, non-specific complications were documented in > 90%. Damage to cord structures and post-operative advice were found in 60% and 30%. Conclusions All grades surgeons were not adequately adherent to BHS, exposing the firm to negligence and complains. Preprepared forms and leaflets are advised to improve the quality of service, in respect to the GMC Domains.

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