P. M. Patel1, A. Mokdad1, A. Webb1,2, S. Huerta1,2 1University Of Texas Southwestern Medical Center,Dallas, TX, USA 2VA North Texas Health Care System,Surgery,Dallas, TX, USA
Introduction: Recurrence following open repair of inguinal hernias continues to be an important complication following repair. We hypothesize that there are factors that can determine recurrence such that these patients can undergo an alternative repair.
Methods: This a retrospective, single institution, single surgeon experience at the VA North Texas Health Care system between July 2005 to July 2015. All patients underwent the same standardized mesh repair. Using recurrence as the dependent variable, univariate analysis (UA) was performed using Fisher’s Exact Test for categorical and Student’s T-Test for continuous variables. Clinically relevant variables and variables with a p ≤ 0.2 were entered in a logistic regression model with recurrence as the dependent variable. Data are expressed as means ± SD and significance was established at a p ≤0.05 (two-sided).
Results: During the study period, 804 patients underwent open inguinal hernia repair (99.3 ± 0.3% male, 60.4 ± 12.4 years-old, BMI 26.7 ± 4.2 Kg/m2, 72.9% Caucasian, American Society of Anesthesiologists class average of 2.5, morbidity rate of 7.8 ± 0.9%) by the same surgeon. Sixteen recurrences were identified (2.0 %). Median follow up was 4.7 ± 2.7 years. Patients with recurrent hernia were less likely to have an indirect hernia (25.0 ±10.8% vs 54.3 ± 1.8%, p=0.02), and more likely to have a small bowel obstruction (6.3 ± 6.1 % vs 0.6 ± 0.3 %, p=0.01), a bowel resection (6.3 ± 6.1% vs 0.5 ± 0.3%, p <0.001), and a longer operative time (76.7 ± 28.7% vs 63.7 ± 22.1%, p=0.02). These patients were also more likely to be smokers (56.3 ± 12.4% vs 32.9 ± 1.7%, p=0.05). Multivariate analysis demonstrated that current smoking history (OR and 95% CI: 3.3; 1.2 – 9.3), OR time (1.1; .1.0 – 1.1), and repair of an indirect inguinal hernia (0.2; 0.04 – 0.5) were independent predictors of recurrence.
Conclusion: Patients with direct complex hernias are more likely to develop a recurrence. Current smokers should be told to stop smoking prior to repair.