O11 SEX DIFFERENCES, SLEEP DISTURBANCE AND RISK OF PERSISTENT PAIN ASSOCIATED WITH GROIN HERNIA SURGERY: A NATIONWIDE REGISTER-BASED COHORT STUDY

Aim Persistent pain after groin hernia repair is a major health problem. Sleep disturbance is associated with heightened pain sensitivity. The main objective of this study was to examine the role of sleep disturbance in the development and long-term maintenance of chronic postherniorrhaphy inguinal pain (CPIP), with exploration of sex differences. Material and Methods From 2012-2017, a national cohort of patients with prior groin hernia repair (n = 2084; 45.8% females) were assessed for the development of CPIP 12 months after surgery. Patients then underwent long-term (median 5.0 years) follow-up to evaluate the contribution of sex and sleep disturbance on the maintenance of CPIP. Associations between pre- and postoperative sleep problems (assessed at long-term follow-up) and CPIP were tested using logistic regression. Results Females had higher rates of CPIP with negative impact on daily activities 12 months after surgery as compared to males (14.6 vs 9.2%, p<0.0005), and were more likely to have moderate-severe CPIP in the long-term (3.1 vs 1.2%, p=0.003). Preoperative sleep problems predicted development of CPIP 12 months after surgery (adjusted odds ratio (aOR) 1.76 (95%CI 1.26-2.46), p=0.001) and CPIP in the long-term (aOR 2.20 (1.61-3.00), p<0.0001). CPIP was associated with insomnia and depression. Conclusions Sleep disturbance may increase the risk for CPIP, and contribute to maintenance of postsurgical pain. Females are at heightened risk for CPIP as compared to males. Given the robust associations between sleep disturbance and CPIP, interventions which consolidate and promote sleep, especially in females, may improve long-term pain control.

P113 SPIN IS PRESENT IN THE MAJORITY OF THE ARTICLES EVALUATING ROBOT-ASSISTED GROIN HERNIA REPAIR: A SYSTEMATIC REVIEW

Aim The number of articles published each year are increasing, resulting in greater competition to get work published. Spin is defined as specific reporting strategies used to distort the readers’ interpretation of results so that they are viewed more favourable. However, prevalence of spin in studies comparing robot-assisted groin hernia repair with traditional methods is unknown. The aim of the study was to determine the frequency and extent of misrepresentation of results, spin, in studies assessing robot-assisted groin hernia repair. Methods This systematic review was reported according to PRISMA guidelines, and a protocol was registered at PROSPERO before data extraction. Database search included PubMed, EMBASE and Cochrane Central. Results Of 35 included studies, spin was present in 57%. Within these, 95% had spin present in the abstract and 80% in the conclusion of the article. There was no association between study size and spin (p > 0.05). However, presence of spin in studies positively minded towards robot-assisted hernia repair was higher (p < 0.001) compared with those against or being neutral in their view of the procedure. Furthermore, being funded by or receiving grants from Intuitive Surgical were associated with a higher prevalence of spin (p < 0.01) compared with those who were not. Conclusion Spin was found to be common in articles reporting on robot-assisted groin hernia repair, and presence of spin was higher in studies funded by or receiving grants from the robot company. This suggests that readers should be cautious when reading similar literature.

O25 MORTALITY AFTER EMERGENCY VERSUS ELECTIVE GROIN HERNIA REPAIR: A SYSTEMATIC REVIEW AND META-ANALYSIS

Aim This systematic review and meta-analysis aimed to investigate 30- and 90-day postoperative mortality in patients undergoing emergency or elective groin hernia repair. Material and Methods This review is reported after the PRISMA 2020 guidelines. A protocol (CRD42021244412) was registered to PROSPERO. Three databases (PubMed, EMBASE, and Cochrane CENTRAL) were searched in April 2021. The identified studies were screened for eligibility and included if they reported 30- and/or 90-day mortality following emergency or elective groin hernia repair. Meta-analyses were conducted when possible, and a subgroup analysis on patients undergoing bowel resection was made. Results We included 37 studies with a total of 30,740 patients receiving emergency repair and 457,253 receiving elective repair. Meta-analyses could not be conducted for the two repair settings separately due to heterogeneity. However, the 30-day mortality ranged from 0.0–1.7% following elective repair and 0.0–11.8% following emergency repair. The risk of 30-day mortality following emergency repair was estimated to be 26-fold higher than after elective repair. A subgroup meta-analysis on bowel resection in emergency repair estimated 30-day mortality to be 7.9%. Conclusions Emergency groin hernia remains a challenging and potentially fatal surgical emergency. This review emphasizes the importance of performing hernia repair in an elective setting to prevent a potential acute presentation with acute surgical intervention. Patients presenting with symptoms of emergency groin hernias should receive particular attention to minimize the high risk of mortality and morbidity following emergency repair.

Long-term pain relief after groin hernia repair for sports groin: A nationwide cohort study

Background: The groin is a complex anatomical area with multiple structures that can be injured and cause pain. One condition with groin pain is the so-called “sports groin,” which can be treated with a groin hernia repair even though no hernia is present. The aim of this study was to assess the prevalence of chronic groin pain several years after a groin hernia repair performed in patients with a sports groin. Methods: This nationwide cohort study included adults who had a groin hernia repair for a sports groin through the years 1998–2011. The patients were identified through the Danish Hernia Database and in surgical records. Patients were asked to fill out four questionnaires several years after the repair: a visual analogue scale, the Activity Assessment Scale, the Inguinal Pain Questionnaire, and a questionnaire about treatment satisfaction. Results: Of 118 contacted patients, 71 gave informed consent and were included in the study (60%), and of these the response rate was 100%. The questionnaires were filled out median 14 years after surgery. Most of the patients were pain-free in the operated groin (87%), and only a few had physical impairment caused by groin pain (20%). Prior to surgery, 79% had groin pain that they could not ignore. Overall, 90% of the patients were satisfied with the treatment. Conclusions: Most patients were pain-free and without physical impairment several years after groin hernia repair for a sports groin and with high satisfaction rate.

EP.TH.747Audit of antibiotic prophylaxis in groin hernia repair

Aims To review practice of antibiotic prophylaxis in patients undergoing groin hernia repair against the International guidelines for groin hernia management 2018, in order to improve compliance with International Guidelines. We also assessed the risk category of patients. Methods Retrospective data of all patients undergoing groin hernia repair from November 2019 to March 2020 was collected using hospital software. Data collected included patient demographics, details of hernia repair including; primary/recurrent hernia, emergency/elective, laparoscopic/open repair and use of mesh. The details of antibiotic prophylaxis were recorded. Descriptive statistics was used. Data was analyzed using Microsoft Excel. Results 67 patients were included, of which 38(57%) were high risk. 62 (92.5%) primary repairs were done, of which 48(72%) were open. 62(92.5%) were operated electively. 46(69%) patients underwent open repair with mesh, 6(9%) had open repair without mesh, while 15(22%) had laparoscopic repair with mesh. A total of 45 (67%) patient received antibiotic prophylaxis. Adherence to International guidelines for groin hernia in open hernia surgery was 82.67%, while that for laparoscopic surgery was 60%. Overall adherence to the Guidelines was 56.67%. Conclusions The audit reflects the need for improved understanding and adherence to the International Guidelines. Data collection of surgical site infection can help inform and influence practice to minimize the risk for surgical site infection and assist in better communication with patients regarding risk. Risk assessment for surgical site infection of patients prior to procedure helps to identify those with indication of antibiotic prophylaxis.

TP9.2.13Outcomes of Emergency Groin hernia repair: 30-months experience of a tertiary care hospital

Aims Repair of Emergency groin hernia is variable across different regions and even within same units. Mesh is increasingly used these days. We aim to evaluate peri-operative and long-term outcomes over last 30-months. Methods Retrospective analysis of all emergency groin hernia repairs from January 2018- July 2020 in a tertiary Centre. Case notes and electronic patient records (clinical portal, PACS system etc.) used for data collection. Results Of 89 emergency groin hernia repairs 62(69.7%) males, 32/89 (35.9%) indirect inguinal hernia and 29 (32.5%) femoral hernia. Median age 72 years (range 20-95), 74(83.1%) primary hernia and 15(16.9%) recurrent hernias. Femoral hernia was most common in females 25/27 (92.5%) in contrast 58/62 males (93.5%) had inguinal hernia. All patients, except 1(1.1%) laparoscopic, had open repair, 11/89 cases (12.3%) required bowel resection, of those 10 (90.9%) had suture repair. Additionally, 6/89 cases (6.7%) needed laparotomy. Of 68/89 (76.4%) cases who had mesh repair, 52(76.4%) were inguinal and 23.5% (16/68) femoral hernia. Only 55% femoral hernias repaired with mesh. Median LOS was 3 days (range 0-54), 6/89 cases (6.74%) had wound complications (3 wound infections, 2 haematoma and 1 fluid collection). With median 19 months (range 6-36 months) follow-up, 1(1.1%) recurrence each in both mesh and suture repair groups, no mesh infection and 2/89 (2.2%) 30-day mortality recorded. Conclusion Mesh repair is increasingly used in emergency groin hernia repair without increased risk of mesh infection, although suture repair is still preferred in groin hernias requiring bowel resection.

EP.TH.336Surgeons' Knowledge Of Characteristics of Mesh Used in Groin Hernia Repair- A Cross Sectional Survey

Aims We aim to assess the surgeons’ awareness of mesh characteristics by way of an online survey. Methods A cross sectional survey of surgeons routinely performing groin hernia repairs was conducted across five NHS hospitals using an online questionnaire. Surgeon’s experience in groin hernia repair was taken in account. The data was analyzed using Microsoft Excel. Descriptive statistics was used. Results 37 surgeons responded to the survey.6 surgeons had more than 20 years of experience. 8 (21.62%) performed >50 hernia repairs annually. When compared with years of experience, knowledge of material was 100% with >10 years experience. Knowledge of tensile strength was 50% in those with > 20 years experience, while 83% of respondents with >20 years experience were aware of the weight and pore size of the mesh they used. In comparison with the number of groin hernia repairs done annually, all respondents performing >50 repairs knew the material they used. Amongst these respondents, knowledge of tensile strength, weight and pore size was 38%, 75% and 63% respectively. Conclusions Our study suggests that the level of knowledge regarding mesh is inadequate among surgeons, falling short of the minimum expected of surgeons performing groin hernia repair.

Risk factors for surgical site infection after groin hernia repair: does the mesh or technique matter?

Introduction Surgical site infections (SSIs) following groin hernia repair (GHR) are getting rarer in high income countries despite a wider use of meshes. Among the risk factors for SSIs, those related to the mesh and the surgical technique have rarely been described. Methods A registry-based multicenter study using prospectively collected data, including SSIs and their potential risk factors, was conducted in the French Hernia-Club. Results Between 2012 and 2019, 21,976 consecutive unselected adult patients aged 64.8 ± 15.4 years old (88.9% male) underwent GHR (83.5% unilateral). Fifty four percent were laparoscopic; 97.6% used mesh. The overall incidence of SSI was 0.26%. The incidence of SSI was respectively, 0.24% and 0.19% (p = 0.420) in open vs laparoscopic repairs; 0.19% and 0.25% (p = 0.638) for polyester vs polypropylene mesh; In adjusted multivariate analysis focusing on macroporous meshes (which were the most implanted meshes: 23,148 out of 24,099), there were no differences in terms of SSIs’ rates regarding the technique: open versus laparoscopy (p = 0.762) nor the type of mesh used: polypropylene versus polyester (p = 0.557). Conclusion The rate of SSI following GHR was low in this large registry study. Mesh type and surgical technique did not affect SSIs rates. Caution is advised when interpreting these data due to this very low rate of SSI and the potential for a type II error.