Laparoscopic repair is superior to open techniques when treating primary groin hernias in women: a nationwide register-based cohort study

Line Schmidt, Stina Öberg, Kristoffer Andresen, Jacob Rosenberg

Few studies have described recurrence rates after groin hernia repair in women. Our aim was to investigate if laparoscopic repair of primary groin hernias in women results in a lower reoperation rate for recurrence compared with open repairs. Furthermore, we wished to compare hernia subtypes at primary repair and reoperation. This nationwide cohort study was reported according to the RECORD statement. We used prospectively collected data from the Danish Hernia Database to generate a cohort of females operated for a primary groin hernia from 1998 to 2017. Our primary outcome was reoperation for recurrence. The secondary outcome was subtype of hernia at primary repair and reoperation. All females had at least 6-month follow-up. We included 13,945 primary groin hernia operations in women, of whom 649 had undergone a reoperation for recurrence. Median follow-up time was 8.8 years. The cumulative reoperation rates were lower after laparoscopic repair compared with the open techniques, for both inguinal hernias (1.8 vs. 6.3%, p < 0.001) and femoral hernias (2.2 vs. 5.5%, p = 0.005). After laparoscopic repair, 25% of inguinal hernias recurred as femoral, compared with 47% after Lichtenstein (p < 0.001). Direct inguinal hernias and femoral hernias had higher risk of reoperation for recurrence after open repair compared with indirect inguinal hernias. For laparoscopic procedures, hernia subtypes at the primary groin hernia repair had similar reoperation rates. Laparoscopic repair of primary groin hernia in women had lower reoperation rates and fewer femoral recurrences than open repair techniques.