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Recurrence Rates After Repair of Inguinal Hernia in WomenA Systematic Review

Educational Objective To identify the types of recurrences in women who have undergone a primary inguinal hernia repair.
1 Credit CME
Key Points

Questions  What are the recurrence rates after repair of primary inguinal hernia in women, and what types of recurrent hernias are seen?

Findings  In this systematic review including 55 studies comprising 43 870 women, the crude recurrence rate in randomized clinical trials and prospective studies was 1.2% after laparoscopic repair of inguinal hernia, compared with 4.9% after open repair. The recurrent hernia was a femoral hernia in 41% of the patients after open repair compared with 0% after laparoscopic repair.

Meaning  The findings support the recommendation that women with inguinal hernias should preferably undergo laparoscopic repair.

Abstract

Importance  To our knowledge, a systematic review has not yet been performed that specifically addresses the management of inguinal hernia in women. Recurrence after repair of inguinal hernia is not unusual in women and may be a previously undiagnosed femoral hernia, which is rarely seen in men.

Objective  To investigate rates and types of recurrences in women who had undergone repair of primary inguinal hernia.

Evidence Review  PubMed, Embase, and the Cochrane databases were searched in September 2017 for studies reporting recurrences after repair of primary inguinal hernia in women. Crude rates of recurrence (number of recurrences/number of women) were calculated after open and laparoscopic repairs, and the type of recurrent hernia was registered, if noted in the studies. This review is reported according to the PRISMA guideline.

Findings  A total of 55 studies were included, comprising 43 870 women (mean age, 42-69 years; median age, 57 years). Five studies were randomized clinical trials, 14 were prospective cohort studies, 7 were prospective database studies, and 29 were retrospective cohort studies. Twenty studies reported recurrence after laparoscopic repair, with a crude recurrence rate of 1.2% (27 of 2257) (range, 0%-5%) and a median follow-up of 24 months. Thirty-seven studies reported open repair, with a crude recurrence rate of 2.4% (818 of 33 971) (range, 0%-12.5%) and a median follow-up of 36 months. The crude recurrence rate in randomized clinical trials and prospective studies was 1.2% (18 of 1525) after laparoscopic repair compared with 4.9% (490 of 10 058) after open repair. The recurrent inguinal hernia was a femoral hernia in 203 of 496 patients (40.9%) after open repair, compared with 0% of patients after laparoscopic repair. Recurrence rates were similar when open mesh vs nonmesh techniques were used.

Conclusions and Relevance  Recurrence rates after repair of primary inguinal hernia in women are lower after laparoscopic repair compared with open repair. Intraoperative findings during repair of recurrent inguinal hernia are often femoral hernias in women.

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Article Information

Accepted for Publication: May 15, 2018.

Corresponding Author: Line Schmidt, BSc, Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark (lineschmidt12@gmail.com).

Published Online: October 31, 2018. doi:10.1001/jamasurg.2018.3102

Author Contributions: Ms Schmidt had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Schmidt.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Schmidt.

Obtained funding: Rosenberg.

Administrative, technical, or material support: Rosenberg.

Supervision: Öberg, Andresen, Rosenberg.

Conflict of Interest Disclosures: Dr Andresen reported receiving personal fees from Bard outside the submitted work. Dr Rosenberg reported receiving personal fees from Bard and Merck outside the submitted work. No other disclosures were reported.

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