C. Timmerman1, H. Zhu1, T. Pham1, S. Kukreja1, S. Huerta1 1University Of Texas Southwestern Medical Center,Dallas, TX, USA
Introduction: Many techniques are currently available for the repair of inguinal hernias. As inguinal hernias are one of the most common operations performed by general surgeons, any aspect associated with outcomes and cost should be analyzed. We hypothesized that open inguinal hernia repair (OHR) is associated with superior outcomes and less operative time compared to laparoscopic (LHR) and robotic (RHR) repair.
Methods: This is a single institution retrospective review of patients undergoing open (n=1100), laparoscopic (n=128) and robotic (n=71) inguinal hernia repair at the VA North Texas Health Care system between 7/05 and 6/17. Univariate analysis was performed using Fisher’s Exact Test for categorical and Student’s T-Test for continuous variables. We excluded 61 patients with both bilateral and recurrent hernia. For the remaining 1238 patients (964 unilateral, 165 bilateral, and 109 recurrent) variables with a univariable p≤0.15 were entered in a backward selection algorithm to yield the parsimonious multivariable regression model. Multivariable logistic regression analyses (MVA) were used to assess the association between treatment and overall complication rate, adjusting for hernia type (unilateral, bilateral, and recurrent). Data are expressed as means ± SD and significance was established at a p≤0.05 (two-sided).
Results: All patients were men and slightly overweight. Compared to the OHR, the LHR patients were three years older. Complex hernias were substantially more common in the LHR and RHR compared to the OHR cohort. All patients had similar comorbidities except for a history of cardiac disease which was more common in patients with OHR compared to both LHR and RHR (all p’s <0.05). Univariate analysis showed that: OR time [65.5±26.1 vs. 78.4±27.1 vs. 117.5±61.8 (both p’s<0.001)]; inguinodynia [1.5% vs. 26.6% vs. 28.2% (both p’s < 0.001)]; and overall complications [11.2% vs. 34.4% vs. 38% (both p’s < 0.001)] were fewer for OHR compared to both LHR and RHR. Recurrence for OHR was similar to LHR, but less than RHR [1.7% vs. 3.9 vs. 5.6% (p=0.1 OHR vs. LHR; p=0.04 OHR vs. LHR)]. Adjusting for hernia type, RHR was significantly associated with a longer OR time compared with OHR (p<0.001), while LHR is significantly associated with a shorter OR time compared with OHR (p<0.001). MVA also showed that LHR or RHR surgery has a significantly higher overall complication risk compared to OHR.
Conclusion: For unilateral hernia repair, the open approach remains the gold standard operation. LHR and RHR are associated with a higher rate of overall complications. Randomized controlled trials are needed to more conclusively demonstrate the best approach to IHR.