Introduction In September 2004, the National Institute for Health and Care Excellence (NICE) extended their recommendations for laparoscopic inguinal hernia repair to all patients from previous guidelines pertaining to bilateral and recurrent hernias. Despite these changes in policy little is known about short-term complications that are encountered in the primary care setting.
Method Linked primary (Clinical Practice Research Datalink – CPRD) and secondary (Hospital Episode Statistics – HES) care records were used to evaluate outcomes from inguinal hernia repair in England. Patients undergoing primary inguinal hernia repair between 1997 and 2012 were evaluated. In-hospital complicaitons were measured in HES, out-of-hospital complications were measured in CPRD and reoperation for recurrence was measured in HES.
Results From these datasets, 34400 primary hernia repairs performed in 32410 patients were evaluated. Of these repairs, 7.4% (2541/34400) were performed laparoscopically. The proportion of laparoscopic inguinal hernia repair increased after the introduction of guidelines in September 2004. Short-term complications were lower for laparoscopic (1.85% – 47/2541) compared with open (3.57% – 1138/31859) repair, but surgery for recurrence was more frequent following laparoscopic repair (laparoscopic 3.31% 84/2541, open 1.15% 366/31859) (p < 0.001). There were no differences in the rate of short-term complications before (3.53% – 18405) and after (3.35% – 536/15995) the introduction of guidelines, while surgery for recurrence was more frequent after the introduction of guidelines (pre-guidelines 1.50% 240/15755, post-guidelines 1.14% 210/18405, p = 0.004). Independent predictors of short-term complications were age (OR = 1.01), body mass index (OR = 1.03), peptic ulcer disease (0.002), respiratory disease (OR = 1.26), bilateral repair (OR = 1.50), open surgery (OR = 1.38) and emergency surgery (OR = 2.13) (p < 0.05). Independent predictors of surgery for recurrence included bilateral repair (OR = 3.67), laparoscopic repair (OR = 1.49), surgery after the introduction of guidelines (OR = 1.24) and wound infection (OR = 1.79) (p < 0.05).
Conclusion Laparoscopic inguinal hernia repair was associated with significantly lower short-term complication rates compared with open surgery, but significantly increasaed rates of surgery for recurrence. It is important that further dissemination of the technique is accompanied by adequate training to ensure longer term durability.
Disclosure of interest None Declared.