Thirty-day and one-year outcomes were comparable for the four major surgical approaches to groin hernia.

Many patients with groin hernias have four options for a surgical approach: open repair, laparoscopic or robotic transabdominal preperitoneal repair, or laparoscopic total extraperitoneal repair. In this study, researchers accessed data from a US registry of 424 surgeons who performed unilateral groin hernia repairs in 14,000 patients between 2015 and 2022. Using propensity-score matching, they compared outcomes for 1600 patients in each of the four surgical-approach groups.

About 95% of patients had inguinal hernias, and about 5% had femoral hernias. Findings were as follows:

• no significant differences were noted among the four surgical approaches in 30-day rates of recurrence, reoperation, surgical site infection or hospital readmission (1% or less for each of these outcomes)
• postoperative seroma occurred more commonly with laparoscopic transabdominal preperitoneal repair (8%) than with the other approaches (2% to 4%)
• one-year recurrence rates were not significantly different across the four groups (about 6%).

Comment: Individual surgeons might prefer one technique or another, but these relatively recent data provide reassurance that outcomes are comparable across the four surgical approaches to groin hernia. One difference between the approaches that might influence some decisions is that open repair often can be done under local anaesthesia with sedation, whereas the others require general anaesthesia.

Allan S. Brett, MD, Clinical Professor of Medicine, University of Colorado School of Medicine, Aurora, USA.

Lima DL, et al. Current trends and outcomes for unilateral groin hernia repairs in the United States using the Abdominal Core Health Quality Collaborative database: a multicenter propensity score matching analysis of 30-day and 1-year outcomes. Surgery 2024; 175: 1071-1080.

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Gastroenterology.