P. M. Patel1, A. Mokdad1, S. Kukreja1,2, S. Huerta1,2 1University Of Texas Southwestern Medical Center,Dallas, TX, USA 2VA North Texas Health Care System,Dallas, TX, USA
Introduction: Following open inguinal hernia repair, it is possible that a patient will present with an inguinal hernia on the opposite side that requires a subsequent surgery. We hypothesize that there are factors that can determine which patients will need a subsequent inguinal herniorrhaphy, allowing for an improved treatment plan that could involve fewer surgeries.
Methods: This a retrospective, single institution, single surgeon experience at the VA North Texas Health Care system between July 2005 to July 2015. Thus, all patients underwent the same standardized mesh repair. Using need for contralateral repair as the dependent variable, univariate analysis (UA) was performed using Fisher’s Exact Test for categorical and Student’s T-Test for continuous variables. All clinically relevant variables or those with a p ≤0.2 were entered in a multivariable logistic regression model with contralateral herniorrhaphy 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, 623 patients underwent open inguinal hernia repair (99.7 ± 0.2% male, 59.92 ± 12.4 years in age, 26.9 ± 4.1 BMI, 72.3% Caucasian, American Society of Anesthesiologists average class of 2.5, morbidity rate of 6.6 ± 1.0%) by the same surgeon. Twenty-eight patients with metachronous hernias were identified (4.5%). Median follow up was 4.7 ± 2.7 years. The median time for a contralateral repair was 25.4 months. Complications with patients presenting for a contralateral repair were similar to the entire cohort (7.1 ± 4.9% vs 6.6 ±1 .0%; p=0.9). Univariate analysis demonstrated that patients with metachronous hernia repair were more likely to have a history of alcohol abuse (67.9±8.8% vs 40.7±2.0%, p=0.005). Multivariate analyses only demonstrated history of alcohol abuse to be an independent predictor of a contralateral repair (OR and 95% CI: 3.0, 1.3-7.0).
Conclusion: This study demonstrates that the incidence of metachronous hernias in veteran patients is low and the rate of recurrence and morbidity is similar to initial repair.