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Influencing Factors on the Outcome in Female Groin Hernia Repair

A Registry-based Multivariable Analysis of 15,601 Patients

Köckerling, Ferdinand, MD*; Lorenz, Ralph, MD; Hukauf, Martin, MSc; Grau, Henning, MD§; Jacob, Dietmar, MD; Fortelny, René, MD||; Koch, Andreas, MD**

doi: 10.1097/SLA.0000000000003271
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Objective: Based on an analysis of data from the Herniamed Registry, this study aims to identify all factors influencing the outcome in female groin hernia repair.

Background: In a systematic review and meta-analysis of observational studies, female sex was found to be a significant risk factor for recurrence. In the guidelines, the totally extraperitoneal patch plasty (TEP) and transabdominal preperitoneal patch plasty (TAPP) laparo-endoscopic techniques are recommended for female groin hernia repair. However, even when complying with the guidelines, a less favorable outcome must be expected than in men. To date, there is no study in the literature for analysis of all factors influencing the outcome in female groin hernia repair.

Methods: In all, 15,601 female patients from the Herniamed Registry who had undergone primary unilateral groin hernia repair with the Lichtenstein, Shouldice, TEP or TAPP technique, and for whom 1-year follow-up was available, were selected between September 1, 2009 and July 1, 2017. Using multivariable analyses, influencing factors on the various outcome parameters were identified.

Results: In the multivariable analysis, a significantly higher risk of postoperative complications, complication-related reoperations, recurrences, and pain on exertion was found only for the Lichtenstein technique. No negative influence on the outcome was identified for the TEP, TAPP, or Shouldice techniques. Relevant risk factors for occurrence of perioperative complications, recurrences, and chronic pain were preoperative pain, existing risk factors, larger defects, a higher body mass index (BMI), higher American Society of Anesthesiologists (ASA) classification and postoperative complications. Higher age had a negative association with postoperative complications and positive association with pain rates.

Conclusions: Female groin hernia repair should be performed with the TEP or TAPP laparo-endoscopic technique, or, alternatively, with the Shouldice technique, if there is no evidence of a femoral hernia. By contrast, the Lichtenstein technique has disadvantages in terms of postoperative complications, recurrences, and pain on exertion. Important risk factors for an unfavorable outcome are preoperative pain, existing risk factors, higher ASA classification, higher BMI, and postoperative complications. A higher age and larger defects have an unfavorable impact on postoperative complications and a more favorable impact on chronic pain.

*Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Berlin, Germany

Hernia Center 3+CHIRURGEN, Klosterstrasse 34/35, Berlin, Germany

StatConsult GmbH, Halberstädter Strasse 40 a, Magdeburg, Germany

§Health Center Gropiusstadt, Orthopedic—Surgical—Practice g-g-h-z, Lipschitzallee, Berlin, Germany

Orthopedic—Surgical—Practice, Kaiser-Wilhelm-Strasse 24-26, Berlin, Germany

||Department of General Surgery, Wilhelminenhospital, Sigmund Freud University, Medical Faculty, Montleartstrasse 37, Vienna, Austria

**Hernia Center Cottbus, Gerhard-Hauptmann-Strasse 15, Cottbus, Germany.

Reprints: Ferdinand Köckerling, MD, Vivantes Hospital Berlin, Berlin, Germany. E-mail: ferdinand.koeckerling@vivantes.de.

F.K. and R.L. Both authors contributed equally to this publication.

The authors have no conflicts of interest.

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