Objective: To describe the characteristics of patients undergoing multiple groin hernia repairs and to identify strategies that prevent further recurrence.
Summary Background Data: Although relatively infrequent, recurrent groin hernias where several repairs have previously been undertaken constitutes a major problem in hernia surgery. Low numbers and heterogeneity have made it difficult to perform large prospective studies on this group.
Methods: The study was designed as an observational population-based register study. All repairs for recurrent hernia recorded in the Swedish Hernia Register (SHR) 1992–2006 were identified. Risk for reoperation by number of previous repairs, with adjustment for gender and age, and risk for reoperation by unit responsible for previous repair were determined using Cox proportional hazard analysis.
Results: There were 12,104 cases of hernia repaired once, 2 repairs in 4199 cases, 3 repairs in 310 cases, 4 repairs in 32 cases, and 5 repairs in 3 cases. The risk for further reoperation increased with the number of previous repairs (P < 0.001). The hazard ratios for reoperation following open preperitoneal mesh repair and laparoscopic repair decreased; whereas, the hazard ratio for sutured repair increased with the number of previous repairs. The difference between Lichtenstein repair and laparoscopic repair was significant for the first 2 repairs (P < 0.05).
Conclusion: Laparoscopic preperitoneal repair provides the best surgical outcome in repeated groin hernia recurrence.
The more repairs performed in the same groin, the more unfavorable is the outcome. Laparoscopic repair and open preperitoneal mesh repair give a better outcome where several repairs have been previously performed in the same groin.
From the *Department of Surgery, University Hospital of Lund, Lund, Sweden; †CLINTEC, Division of Surgery, Karolinska Institute, Stockholm, Sweden; ‡Department of Surgery, Östersund Hospital, Östersund, Sweden; §Department of Surgery, Umeå University Hospital, Umeå, Sweden; and the ¶Department of Surgery, University Hospital of Lund, Lund, Sweden.
This work was supported by a grant from the Thelma Zoéga Foundation.
Reprints: Dan Sevonius, MD, Department of Surgery, University Hospital of Lund, 221 85 Lund, Sweden.