Comparison of open and laparo-endoscopic repair techniques for patients with bilateral inguinal hernias.

INTRODUCTION

For primary bilateral inguinal hernias, international guidelines favor a laparoscopic posterior mesh repair due to relatively lower risk of acute and chronic pain, faster recovery, and favorable biomechanical properties compared to open anterior approaches (Lichtenstein, plug and patch, etc.). However, studies comparing open mesh-based bilateral inguinal hernia repairs to bilateral laparoscopic and robotic mesh-based approaches are limited. The Abdominal Core Health Quality Collaborative (ACHQC) registry includes longitudinal data on bilateral inguinal hernia repairs performed via open as well as laparo-endoscopic approaches. We hypothesize that outcomes for bilateral inguinal hernia repair are similar between open and laparo-endoscopic approaches in the ACHQC registry.

METHODS

Data from 2012 to 2024 was obtained from the ACHQC registry for individuals who underwent open and laparo-endoscopic bilateral inguinal hernia repair. After adjusting for confounding covariates, 3:1 propensity score-based matching was performed to compare patient-reported quality of life using EuraHS scores between the open, robotic, and laparoscopic bilateral inguinal hernia repair cohorts. Postoperative complications and hernia recurrences were also compared between these cohorts.

RESULTS

In the matched analysis between laparoscopic, robotic, and open repair groups, 575, 524, and 208 individuals, respectively, were included. In the combined analysis comparing laparo-endoscopic to open repairs, data was included for 627 and 211 individuals, respectively, after propensity score matching with 3-year follow up. The open cohort comprised of approximately 40% open preperitoneal and 60% Lichtenstein repairs. The mean age of individuals in this study was 63 years (± standard deviation of 8 years), with nearly 92% of the patients being male (772/838). EuraHS scores up to the 3-year follow-up timepoint did not show statistical or clinical differences between the study cohorts (p = 0.19). There were also no significant differences between the rates of hernia recurrence at 3-year follow up, 30-day surgical site occurrences, postoperative bleeding, peripheral nerve injury, venous thromboembolic events, and urinary tract infections between the three cohorts.

CONCLUSION

For individuals undergoing primary bilateral inguinal hernia repair, all three approaches- laparoscopic, robotic, and open- are comparable in surgical and patient-reported outcomes in the ACHQC registry. Given the high percentage of open preperitoneal repairs in this study, further investigation is warranted to understand if the "open" cohort outcomes are skewed by the combination of both anterior and posterior open repairs in the same group.