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ORIGINAL ARTICLE
Year : 2017  |  Volume : 50  |  Issue : 3  |  Page : 89-96

Bilateral primary inguinal hernia repair in Taiwanese adults: A nationwide database analysis


1 Department of General Surgery, E-Da Hospital, Kaohsiung; Department of Colorectal Surgery, Dalin Tzu Chi Hospital, The Buddist Tzuchi Medical Foundation, Chia-Yi, Taiwan
2 Department of General Surgery, Dalin Tzu Chi Hospital, The Buddist Tzuchi Medical Foundation, Chia-Yi; School of Medicine, I-Shou University, Kaohsiung, Taiwan
3 School of Medicine, I-Shou University, Kaohsiung; School of Medicine, Tzu Chi University, Hualien, Taiwan

Correspondence Address:
Cheng-Hung Lee
General Surgery, Dalin Tzu Chi Hospital, The Buddist Tzuchi Medical Foundation, No.2, Minsheng Road, Dalin Township, Chiayi County 622
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/fjs.fjs_33_17

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Objective: The objective of this study was to identify the long-term rates of and treatment options for recurrence of bilateral primary inguinal hernias following various hernia repair methods, namely, open inguinal hernia repair (OIHR) without mesh, OIHR with mesh (OIHR-M), and laparoscopic inguinal hernia repair (LIHR). Materials and Methods: Data in this retrospective study were retrieved from the Taiwan's National Health Insurance Research Database. All adult patients who underwent primary bilateral inguinal hernia repair were selected from this database using the International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic and procedure codes. Results: From 2000 to 2010, 13,636 adult patients underwent elective bilateral inguinal hernia repair, with a median follow-up of 63.95 months. The risk of recurrence was significantly lower in the LIHR group than in the OIHR group (hazard ratio [HR] =0.691,P = 0.003) and was similar to that in the OIHR-M group (HR = 1.187,P = 0.184). The median recurrence-free period was 28.93 months. After recurrence, 52.6% of patients underwent repair at the same hospital, and 35.5% of patients were operated on by the same surgeons. The LIHR group had a significantly shorter median recurrent period than did the other groups (OIHR, OIHR-M, and LIHR: 33.83, 23.33, 16.56 months, respectively;P < 0.001). Moreover, recurrence occurred in a significantly higher proportion of patients who were treated by the same surgeon (OIHR vs. OIHR-M vs. LIHR = 31.8% vs. 40.1% vs. 48.6%,P < 0.001). Conclusions: In this large cohort study, the recurrence risk was significantly lower in the LIHR group than in the OIHR group and was similar to that in the OIHR-M group, for primary bilateral hernia repair. In addition, the LIHR group experienced similar mortality as the other groups but lower readmission rates. Moreover, the proportion of LIHR patients treated by the same doctor was significantly higher than that of traditional hernia repair patients. In short, LIHR is a reliable procedure and may offer an improved surgical experience for bilateral primary inguinal hernia repair.


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