Andresen, Kristoffer4; Bisgaard, Thue5; Kehlet, Henrik5; Wara, Pål3; Rosenberg, Jacob5
1 Department of Clinical Medicine, Department of Clinical Medicine, Faculty of Health and Medical Sciences, Københavns Universitet2 Graduate School of Health and Medical Sciences, Graduate School of Health and Medical Sciences, Faculty of Health and Medical Sciences, Københavns Universitet3 unknown4 Graduate School of Health and Medical Sciences, Graduate School of Health and Medical Sciences, Faculty of Health and Medical Sciences, Københavns Universitet5 Department of Clinical Medicine, Department of Clinical Medicine, Faculty of Health and Medical Sciences, Københavns Universitet
A Nationwide Analysis
IMPORTANCE: In Denmark approximately 10 000 groin hernias are repaired annually, of which 2% to 4% are femoral hernias. Several methods for repair of femoral hernias are used including sutured repair and different types of mesh repair with either open or laparoscopic techniques. The use of many different approaches reflects a rather low level of evidence for the best method of repair. Randomized clinical trials are lacking. Large, prospective cohort studies are an alternative way of acquiring improved evidence regarding the best type of repair. OBJECTIVE: To investigate the reoperation rate after laparoscopic vs open femoral hernia repair, analyzing data from a nationwide database. DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study was conducted. Data on femoral hernia repairs registered in the Danish Hernia Database from January 1998 until February 2012 were extracted and analyzed. All repairs were followed in the database and analyzed for reports of reoperation, which were used as a proxy for recurrence. Femoral hernia recurrence and inguinal hernia occurrence after the index repair were analyzed. EXPOSURE: Repair of a femoral hernia. MAIN OUTCOMES AND MEASURES: Reoperation for a femoral hernia. RESULTS: A total of 3970 primary femoral hernia repairs were analyzed; 27.3% occurred in men. There were 2413 elective repairs (60.8%) and 1557 emergency procedures (39.2%). In a multivariate analysis, laparoscopic repair was found to result in reduced risk of reoperation (hazard ratio, 0.33; 95% CI, 0.09-0.95) compared with open repair. The risk of reoperation was higher in women (hazard ratio, 1.95; 95% CI, 1.10-3.45). Furthermore, the laparoscopic approach seemed to reduce the risk of subsequent occurrence of an inguinal hernia in the same groin. CONCLUSIONS AND RELEVANCE: Laparoscopic repair of a femoral hernia reduces the risk of reoperation for a recurrence compared with open repair. The results from this study support the guidelines recommending the use of the laparoscopic approach for repair of femoral hernias.
J a M a Surgery, 2014, Vol 149, Issue 8, p. 853-857
Adolescent; Adult; Aged; Aged, 80 and over; Cohort Studies; Denmark; Elective Surgical Procedures; Female; Hernia, Femoral; Humans; Laparoscopy; Male; Middle Aged; Recurrence; Reoperation; Risk Factors; Sex Distribution; Sex Factors; Treatment Outcome; Young Adult