Factors associated with postoperative complications and hernia recurrence for patients undergoing inguinal hernia repair: a report from the VA Cooperative Hernia Study Group. Psychological risk factors for chronic post-surgical pain after inguinal hernia repair surgery: a prospective cohort study. A comparison of outcomes between open and laparoscopic surgical repair of recurrent inguinal hernias Low reoperation rates in young males after sutured repair of indirect inguinal hernia: Arguments for a tailored approach. Higher Recurrence Rate After Endoscopic Totally Extraperitoneal (TEP) Inguinal Hernia Repair With Ultrapro Lightweight Mesh: 5-Year Results of a Randomized Controlled Trial (TULP-trial) The effect of tobacco consumption and body mass index on complications and hospital stay after inguinal hernia surgery EFFECT OF EARLY RETURN TO WORK AFTER ELECTIVE REPAIR OF INGUINAL HERNIA: CLINICAL AND FINANCIAL CONSEQUENCES AT ONE YEAR AND THREE YEARS Laparoscopic repair of recurrent inguinal hernias. Repeated Groin Hernia Recurrences Does Resident Post Graduate Year Influence the Outcomes of Inguinal Hernia Repair? Low Recurrence Rate After Laparoscopic (TEP) and Open (Lichtenstein) Inguinal Hernia Repair: A Randomized, Multicenter Trial With 5-Year Follow-Up Reoperation After Recurrent Groin Hernia Repair Three-year results of randomised clinical trial comparing lightweight mesh with heavyweight mesh for inguinal hernioplasty Laparoscopic extraperitoneal inguinal hernia repair versus open mesh repair: long-term follow-up of a randomized controlled trial. Patient reported outcomes after incisional hernia repair-establishing the ventral hernia recurrence inventory. Randomized Prospective Study of Totally Extraperitoneal Inguinal Hernia Repair: Fixation Versus No Fixation of Mesh Laparoscopic extraperitoneal inguinal hernia repair versus open mesh repair: a prospective randomized controlled trial.
BACKGROUND We sought to determine perioperative variables predictive of complications or recurrence for patients undergoing surgical repair of inguinal hernias . PATIENTS AND METHODS Using data from the Veterans Affairs trial , regression analyses were utilized to identify perioperative factors significantly associated with complications ( overall , short-term and long-term ) , long-term pain , and to develop a risk model for recurrence . RESULTS Recurrent and scrotal hernias were predictors for short term and overall complications , regardless of technique . Older age and higher Mental Component Score of the SF-36 were associated with higher risk of long term complications in the open group while prostatism and increased body mass index were the significant predictors in the laparoscopic group . Long-term pain complaints decreased as patient age increased in both groups . Patient and surgeon factors were predictive of recurrence but varied greatly depending on surgical technique . CONCLUSIONS Regardless of technique , scrotal and recurrent hernias were associated with a greater risk of complications and younger patients had more long-term pain . Predictors of recurrence vary based on surgical technique A significant proportion of patients experience chronic post-surgical pain ( CPSP ) following inguinal hernia surgery .  Psychological models are useful in predicting acute pain after surgery , and in predicting the transition from acute to chronic pain in non-surgical context s. This is a prospect i ve cohort study to investigate psychological ( cognitive and emotional ) risk factors for CPSP  after inguinal hernia surgery . Participants were asked to complete question naires before surgery and 1 week and 4 months after surgery . Data collected before surgery and 1 week after surgery were used to predict pain at 4 months . Psychological risk factors assessed included anxiety , depression , fear-avoidance , activity avoidance , catastrophizing , worry about the operation , activity expectations , perceived pain control and optimism .  The study included 135 participants ; follow-up question naires were returned by 119 ( 88.1 % ) and 115 ( 85.2 % ) participants at 1 week and 4 months after surgery respectively . The incidence of CPSP ( pain at 4 months ) was 39.5 % . After controlling for age , body mass index and surgical variables ( e.g. anaesthetic , type of surgery and mesh type used ) , lower pre-operative optimism was an independent risk factor for CPSP at 4 months ; lower pre-operative optimism and lower perceived control over pain at 1 week after surgery predicted higher pain intensity at 4 months . No emotional variables were independently predictive of CPSP . Further research should target these cognitive variables in pre-operative psychological preparation for surgery Background Inguinal hernia recurrence after surgical repair is a major concern . The authors report their experience with open and laparoscopic repair of recurrent inguinal hernias . Methods After institutional review board approval , a retrospective review was performed with the charts of 197 patients who had undergone surgical repair of recurrent inguinal hernias from January 2000 through August 2009 , and the data for 172 patients who met the inclusion criteria were analyzed .  Surgical variables and clinical outcomes were compared using Student ’s t test , the Mann – Whitney U test , chi-square , and Fisher ’s exact test as appropriate . Results The review showed that 172 patients had undergone either open mesh repair ( n = 61 ) or laparoscopic mesh repair ( n = 111 ) for recurrent inguinal hernias . Postoperative complications were experienced by 8 patients in the open group and 17 patients in laparoscopic group ( p = 0.70 ) . Five patients ( 8.2 % ) in the open group and four patients ( 3.6 % ) in the laparoscopic group had re-recurrent inguinal hernias ( p = 0.28 ) . Four patients in the open group ( 9.5 % ) and no patients in the laparoscopic group had recurrence during long-term follow-up evaluation ( p = 0.046 ) . In the laparoscopic group , 76 patients ( 68.5 % ) underwent  total extraperitoneal  ( TEP ) repair , and 35 patients ( 31.5 % ) had  transabdominal preperitoneal ( TAPP ) repair . Postoperative complications were experienced by 13 patients in the TEP group and 4 patients in the TAPP group ( p = 0.44 ) . Two patients ( 2.6 % ) in the TEP group and two patients ( 5.7 % ) in the TAPP group had re-recurrent inguinal hernias ( p = 0.59 ) . Conclusions This retrospective review showed no statistical difference in the re-recurrence rate between the two techniques during short-term follow-up evaluation . However , the laparoscopic technique had a significantly lower re-recurrence rate than the open technique during long-term follow-up evaluation . Both procedures were comparable in terms of intra- and postoperative complications . Among laparoscopic techniques , TEP and TAPP repair are acceptable methods for the repair of recurrent inguinal hernia . A multicenter prospect i ve r and omized control trial is needed to confirm the findings of this study BACKGROUND The aim of this study was to investigate the reoperation rates after open indirect inguinal hernia repair with and without mesh in young males and other age groups . Younger males have higher risk of developing chronic pain after open inguinal hernia repair with mesh compared with older patients . Avoiding mesh among younger patients could be justified , if they have an acceptable low risk of recurrence compared with other groups and compared with Lichtenstein repair . METHODS Data were extracted from the nationwide Danish Hernia Data base which is recording prospect ively . Included were males with primary indirect inguinal hernia , repaired with Lichtenstein or annulorrhaphy from the period January 1 , 1998 to December 31 , 2015 .  Reoperation rate for recurrence was used as outcome . RESULTS In total 52,281 primary repairs of open indirect inguinal hernia were included of which 49,951 were Lichtenstein repairs and 2330 were annulorrhaphies .  The overall reoperation rates increased year after year in both groups but the 18 - 29 year old males had a significant lower risk of reoperation after annulorrhaphy compared with all other age groups ( cumulative reoperation rate 8.1 % versus 12.5 % , log rank p = 0.001 ) . CONCLUSIONS The cumulative reoperation rate after annulorrhaphy for 18 - 29 year old males was significantly lower compared with all other age groups . When taken into consideration , that young males at the same time have the highest risk of developing chronic pain after mesh repair the results indicate , that annulorrhaphy could be a valid option for young men with indirect inguinal hernias . Thus , we propose a tailored approach for this patient group Objective : The aim of this study was to determine inguinal hernia recurrence rates 5 years after endoscopic totally extraperitoneal ( TEP ) inguinal hernia repair when either lightweight or heavyweight mesh was used . Background : Recurrence is an important complication of inguinal hernia surgery . Higher recurrence rates of Ultrapro lightweight meshes after TEP repair have been demonstrated , yet data regarding long-term follow-up are limited . Methods : From 2010 to 2012 , 950 male adult patients with primary unilateral hernias were r and omized to TEP hernia repair with heavyweight ( Prolene ) or lightweight ( Ultrapro ) mesh . Five years postoperatively , the vali date d PINQ-PHONE telephone question naire was carried out . Participants with a positive question naire reply were scheduled for a clinical visit . A recurrence was defined as a clinical ly detectable bulge in the operated groin on physical examination . Results : Data on development of recurrence could be obtained from 790 patients ( 83.2 % 5-year follow – up rate ) . Four patients presented with a recurrence at the outpatient clinic between 2 and 5 years postoperatively . Thirty-five patients ( 4.6 % ) with a positive PINQ-PHONE reply ( 60.0 % lightweight vs 40.0 % heavyweight ) were physically examined at the outpatient clinic . In 2 patients ( lightweight ) a recurrence was detected . The total 5-year recurrence rate after TEP hernia repair was 2.4 % ( 3.8 % lightweight , 1.1 % heavyweight , P = 0.01 ) . A significantly higher recurrence rate  for lightweight mesh in primary direct hernias was found ( P = 0.003 ) . Conclusions : The overall recurrence rate 5 years after TEP repair was low . Ultrapro lightweight meshes showed higher recurrence rates than heavyweight meshes and are not recommended for endoscopic TEP inguinal hernia repair Background The extent to which lifestyle factors such as tobacco consumption and obesity affect the outcome after inguinal hernia surgery has been poorly studied . This study was undertaken to assess the effect of smoking , smokeless tobacco consumption and obesity on postoperative complications after inguinal hernia surgery . The second aim was to evaluate the effect of tobacco consumption and obesity on the length of hospital stay . Methods A cohort of 12,697 Swedish construction workers with prospect ively collected exposure data on tobacco consumption and body mass index ( BMI ) from 1968 onward were linked to the Swedish inpatient register . Information on inguinal hernia procedures was collected from the inpatient register . Any postoperative complication occurring within 30 days was registered . In addition to this , the length of hospitalization was calculated . The risk of postoperative complications due to tobacco exposure and BMI was estimated using a multiple logistic regression model and the length of hospital stay was estimated in a multiple linear regression model . Results After adjusting for the other covariates in the multivariate analysis , current smokers had a 34 % ( OR 1.34 , 95 % CI 1.04 , 1.72 ) increased risk of postoperative complications compared to never smokers . Use of “ Swedish oral moist snuff ” ( snus ) and pack-years of tobacco smoking were not found to be significantly associated with an increased risk of postoperative complications . BMI was found to be significantly associated with an increased risk of postoperative complications ( P = 0.04 ) . This effect was mediated by the underweighted group ( OR 2.94 ; 95 % CI 1.15 , 7.51 ) . In a multivariable model , increased BMI was also found to be significantly associated with an increased mean length of hospital stay ( P < 0.001 ) . There was no statistically significant association between smoking or using snus , and the mean length of hospitalization after adjusting for the other covariates in the model . ConclusionS moking increases the risk of postoperative complications even in minor surgery such as inguinal hernia procedures . Obesity increases hospitalization after inguinal hernia surgery . The Swedish version of oral moist tobacco , snus , does not seem to affect the complication rate after hernia surgery at all Since January , 1976 , male patients undergoing elective unilateral inguinal herniorrhaphy have been included in a trial to see whether early return to normal activity is associated with an increased recurrence rate and to investigate economic consequences . By June , 1981 , 500 patients had been review ed at one year . 2 patients had defaulted . The first 200 patients had been examined at one year and three years . Recurrence was assessed independently , and recurrences were found of which the patient was unaware . The acceptable definition of recurrence was need for reoperation or a truss . The overall recurrence rate at one year was 3.9 % . At three years no further recurrences were detected in the first 200 patients . There was no difference in the recurrence rate for those in the " early " group with 8 recurrences in a total of 246 patients and 10 recurrences in 245 patients in the control group . the median inactivity period in the " early " group was 48 days , compared with 65 days in the control . This differences of 17 days is significant ( p=0.001 ) . The self-employed " early " group returned to work in a median of 31 days . One-third of workers were losing a median of pounds 31 per week ( range pounds 3- pounds 200 ) . Patients can return to normal activity sooner after inguinal herniorrhaphy than has been advised without increasing the recurrence rate at one year and three years and with considerable monetary benefit to one-third of workers BACKGROUND Repair of  recurrent inguinal hernias  is associated with recurrence rates as high as 30 % and complication rates higher than for primary hernias . PATIENTS AND METHODS In a prospect i ve study , results were evaluated after  laparoscopic transabdominal preperitoneal hernia repair in 192 patients with 200 recurrent inguinal hernias . A total of 132 hernia repairs  followed one previous repair , 41 followed two repairs , 17 followed three repairs , 6 followed four , 3 followed five , and 1 followed six previous repairs . The surgical technique is described . RESULTS Follow-up ranged from 9 to 31 months ( mean 18.4 ) . Twelve patients ( 6 % ) had groin seromas or hematomas ; 3 ( 1.5 % ) had transient thigh numbness . One patient ( 0.5 % ) underwent laparoscopy a second time because of a large hematoma . In 1 patient ( 0.5 % ) , a staple on the n. cutaneus femoris lateralis was removed laparoscopically . Patients described postoperative pain as being much less severe compared with their previous operation . Of the total group , 76 % of patients were able to return to work within 2 weeks of surgery . One recurrence ( 0.5 % ) occurred after 6 months because of too small a prosthetic mesh . CONCLUSIONS This laparoscopic technique can be applied to recurrent hernias , even in difficult cases , with low morbidity rates . Recurrence rates as low as for laparoscopic repair of primary hernias can be expected Objective : To describe the characteristics of patients undergoing multiple groin hernia repairs  and to identify strategies that prevent further recurrence . Summary Background Data : Although relatively infrequent , recurrent groin hernias where several repairs have previously been undertaken constitutes a major problem in hernia surgery . Low numbers and heterogeneity have made it difficult to perform large prospect i ve studies on this group . Methods : The study was design ed as an observational population -based register study . All repairs for recurrent hernia recorded in the Swedish Hernia Register ( SHR ) 1992–2006 were identified . Risk for reoperation by number of previous repairs , with adjustment for gender and age , and risk for reoperation by unit responsible for previous repair were determined using Cox proportional hazard analysis . Results : There were 12,104 cases of hernia repaired once , 2 repairs in 4199 cases , 3 repairs in 310 cases , 4 repairs in 32 cases , and 5 repairs in 3 cases . The risk for further reoperation increased with the number of previous repairs ( P < 0.001 ) . The hazard ratios for reoperation following  open preperitoneal mesh repair and  laparoscopic repair  decreased ; whereas , the hazard ratio for sutured repair  increased with the number of previous repairs . The difference between Lichtenstein repair and laparoscopic repair was significant for the first 2 repairs ( P < 0.05 ) . Conclusion : Laparoscopic preperitoneal repair provides the best surgical outcome in repeated groin hernia recurrence Introduction : We evaluated the effect of the  postgraduate medical education level ( PGY ) of surgery residents  on recurrence of inguinal hernia , complications , and operative time . Methods : Post hoc analysis was performed on prospect ively collected data from a multicenter Veterans Affairs ( VA ) cooperative study . Men were r and omly assigned to open or laparoscopic inguinal hernia repairs with mesh . Surgery residents performed repairs with design ated attending surgeons present throughout all procedures . PGY level of the resident was recorded for each procedure . All patients were followed for 2 years for hernia recurrence and complications . PGY levels were grouped as follows : group I = PGY 1 and 2 ; group II = PGY 3 ; group III = PGY ≥ 4 ; rates of recurrence , complications and mean operative time were compared . Results : A total of 1983 patients underwent hernia repair . group III residents had significantly lower recurrence rates for open repairs when compared with group I ( adjusted odds ratio = 0.24 , 95 % confidence interval [ CI ] , 0.06 , 0.997 ) . The recurrence rate was similar among the groups for laparoscopic repair ( P > 0.05 ) Complication rates were not different for either repair ( P > 0.05 ) . Mean operative time was significantly shorter for group III compared with group I for both open ( −6.6 minutes ; 95 % CI , −11.7 , −1.5 ) and laparoscopic repairs ( −12.9 minutes ; 95 % CI , −19.8 , −6.0 ) and between group II and group I for laparoscopic repair ( −15.0 ; 95 % CI , −24.3 , −5.7 ) . Conclusions : Despite the presence of an attending surgeon , open hernia repairs performed by junior residents were associated with higher recurrence rates than those repaired by senior residents . Lower resident level was associated with increased operative time for both open and laparoscopic repair Objectives : To compare a laparoscopic ( totally extraperitoneal patch ( TEP ) ) and an open technique ( Lichtenstein ) for inguinal hernia repair regarding recurrence rate and possible risk factors for recurrence . Summary Background Data : Laparoscopic hernia repair has been introduced as an alternative to open repair . Short-term follow-up suggests benefits for those patients operated with a laparoscopic approach compared with open techniques ; ie , less postoperative pain and a shorter convalescence period . Long-term results , however , are less well known . Methods : The study was conducted as a multicenter r and omized trial with a 5-year follow-up . A total of 1512 men aged 30 to 70 years , with a primary unilateral inguinal hernia , were r and omized to either TEP or Lichtenstein repair . Results : Overall , 665 patients in the TEP group and 705 patients in the Lichtenstein group were evaluable . The cumulative recurrence rate was 3.5 % in the TEP group and 1.2 % in the Lichtenstein group ( P = 0.008 ) . Test for heterogeneity revealed significant differences between individual surgeons . The exclusion of 1 surgeon , who was responsible for 33 % ( 7 of 21 ) of all recurrences in the TEP group , lowered the cumulative recurrence rate to 2.4 % in this group , which was not statistically different from that of the Lichtenstein group . Conclusions : The recurrence rate for both TEP and Lichtenstein repair was low . A higher cumulative recurrence rate in the TEP group was seen at 5 years . Further analysis revealed that this could be attributable to incorrect surgical technique Objective To analyze reoperation rates for recurrent and primary groin hernia repair documented in the Swedish Hernia Register from 1996 to 1998 , and to study variables associated with increased or decreased relative risks for reoperation after recurrent hernia . Methods Data were retrieved for all groin hernia repairs prospect ively recorded in the Swedish Hernia register from 1996 to 1998 . Actuarial analysis adjusted for patients ’ death was used for calculating the cumulative incidence of reoperation . Relative risk for reoperation was estimated using the Cox proportional hazards model . Results From 1996 to 1998 , 17,985 groin hernia operations were recorded in the Swedish Hernia Register , 15 % for recurrent hernia and 85 % for primary hernia . At 24 months the risk for having had a reoperation was 4.6 % after recurrent hernia repair and 1.7 % after primary hernia repair . The relative risk for reoperation was significantly lower for laparoscopic methods and for anterior tension-free repair than for other techniques . Postoperative complications and direct hernia were associated with an increased relative risk for reoperation . Day-case surgery and local infiltration anesthesia were used less frequently for recurrent hernia than for primary hernia . Conclusions Recurrent groin hernia still constitutes a significant quantitative problem for the surgical community . This study supports the use of mesh by laparoscopy or anterior tension-free repair for recurrent hernia operations Purpose The aim of the present r and omised study was to find out whether usage of lightweight mesh in inguinal hernia repair , compared with heavyweight mesh , results in decreased incidence of chronic groin pain and foreign body feeling , as well as to evaluate the risk factors for chronic pain development and hernia recurrences . Methods The patients were r and omised into the heavyweight mesh ( HW ) group and lightweight mesh ( LW ) group . A tension-free mesh repair using the Lichtenstein technique was performed on all patients . Pain scores during different activities were measured on visual analogue scale . All patients underwent a clinical examination for any evidence of hernia recurrence . Results Of the patients , 17.2 % in the HW group and 29.3 % in the LW group reported that they experienced pain at 3-year follow-up ( P = 0.1323 ) . Pain was most often reported during physical activity . The median VAS score of all studied activities was 30.5 in the HW group and 30.0 in the LW group . There were more patients in the HW group than in the LW group who stated that they could feel the mesh in the groin ( 27.6 vs. 20.7 % , P = 0.3967 ) . Among all patients , 42.9 % who had severe pain preoperatively also reported pain during different activities and 19.6 % of the patients who did not have severe pain preoperatively reported pain during different activities ( P = 0.0481 ) . At 3-year follow-up , there was 1 hernia recurrence in the HW group and 1 hernia recurrence in the LW group . Conclusions Our study shows that compared with HW mesh , LW mesh has no advantage in reducing chronic groin pain and foreign body feeling at the operation site after inguinal hernioplasty at 3-year follow-up . Severe preoperative pain was correlated with the development of chronic pain . There was no difference between the two study groups in the recurrence rates BACKGROUND We have conducted a r and omized controlled trial of totally extraperitoneal hernia repair ( TEP ) versus tension-free open repair ( Lichtenstein repair ) ; we have presented the results previously up to 1 year after the operation . The aim of this study was to compare patient outcome in both groups at a median follow-up of 7.3 years after operation . METHODS Of 168 patients included in a prospect i ve , r and omized controlled trial design ed to compare TEP with an open tension-free technique , 154 patients ( 92 % ) answered a question naire and 147 patients ( 88 % ) were followed up at an outpatient clinic after a minimum of 6 years after operation . RESULTS Overall , 89 % of patients in the TEP group and 95 % of patients in the open group reported complete long-term recovery ( P = .23 ) . Permanent impaired inguinal sensibility was more common in the open group ( P = .004 ) , whereas the proportion of patients with reported testicular pain was higher in the TEP group ( P = .003 ) . Three recurrences were found in the TEP group , and 4 recurrences were found in the open group ( P = .99 ) . Four patients in the TEP group underwent operations for complications related to the hernia repair ( small bowel obstruction , umbilical hernia , testicular pain , and neuralgia ) . CONCLUSION Overall , both groups showed good long-term results with low rates of recurrences . However , the TEP group was associated with a higher proportion of patients with long-term testicular pain , whereas impaired inguinal sensibility was more common in the open group BACKGROUND Assessing incisional hernia recurrence typically requires a clinical encounter . We sought to determine if patient-reported outcomes ( PROs ) could detect long-term recurrence . METHODS Adult patients 1 to 5 years after incisional hernia repair were prospect ively asked about recurrence , bulge , and pain at the original repair site . Using dynamic abdominal sonography for hernia to detect recurrence , performance of each PRO was determined . Multivariable regression was used to evaluate PRO association with recurrence . RESULTS Fifty-two patients enrolled with follow-up time 46 ± 13 months . A patient-reported bulge was 85 % sensitive , and 81 % specific to detect recurrence . Patients reporting no bulge and no pain had 0 % chance of recurrence . In multivariable analysis , patients reporting a bulge were 18 times more likely to have a recurrence than those without ( 95 % confidence interval , 3.7 to 90.0 ; P < .001 ) . CONCLUSIONS This preliminary study demonstrates that PROs offer a promising means of detecting long-term recurrence  after incisional hernia repair , which can help facilitate quality improvement and research efforts Background : Fixation of the mesh during laparoscopic totally extraperitoneal ( TEP ) inguinal hernia repair is thought to be necessary to prevent recurrence . However , mesh fixation may increase postoperative pain and lead to an increased risk of complications . We question ed whether elimination of fixation of the mesh during TEP inguinal hernia repair leads to decreased postoperative pain or complications , or both , without an increased rate of recurrence . Methods : A r and omized prospect i ve single-blinded study was carried out in 40 patients who underwent laparoscopic TEP inguinal hernia repair with ( Group A=20 ) or without ( Group B=20 ) fixation of the mesh .  Results : Patients in whom the mesh was not fixed had shorter hospital length of stay ( 8.3 vs 16.0 hours , P=0.01 ) , were less likely to be admitted to the hospital ( P=0.001 ) , used less postoperative narcotic analgesia in the PACU ( P=0.01 ) , and were less likely to develop urinary retention ( P=0.04 ) . No significant differences occurred in the level of pain , time to return to normal activity , or the difficulty of the operation between the 2 groups . No hernia recurrences were observed in either group ( follow-up range , 6 to 30 months , median=19 ) . Conclusions : Elimination of tack fixation of mesh during laparoscopic TEP inguinal hernia repair significantly reduces the use of postoperative narcotic analgesia , hospital length of stay , and the development of postoperative urinary retention but does not lead to a significant reduction in postoperative pain . Eliminating tacks does not lead to an increased rate of recurrence BACKGROUND This study was design ed to compare an open tension-free technique ( Lichtenstein repair ) with a laparoscopic totally extraperitoneal hernia repair ( TEP ) . METHODS One hundred sixty-eight men aged 30 to 65 years with primary or recurrent inguinal hernia were r and omized to TEP or open mesh technique in the manner of Lichtenstein . Follow-up was after 1 and 6 weeks , and 1 year . RESULTS Eighty-one patients were r and omized to TEP , and 87 to open repair . For 1 patient in each group , the operation was converted to a different type of repair . No difference was seen in overall complications between the 2 groups . However , 1 patient in the TEP group underwent operation for small bowel obstruction after surgery . A higher frequency of postoperative hematomas was seen in the open group ( P < .05 ) . Patients in the TEP group consumed less analgesic after surgery ( P < .001 ) , returned to work earlier ( P < .01 ) , and had a shorter time to full recovery ( P < .01 ) . Two recurrences occurred in the TEP group 1 year after surgery . CONCLUSION The TEP technique was associated with less postoperative pain , a shorter time to full recovery , and an earlier return to work compared with the open tension-free repair . No difference was seen in overall complications . However , 2 recurrences did occur after 1 year in the TEP group
We found that female sex , direct inguinal hernias at the primary procedure , operation for a recurrent inguinal hernia , and smoking were significant risk factors for recurrence after inguinal hernia surgery .
Background .
Several factors influence the risk of recurrence after inguinal hernia surgery ; however , a systematic review and meta- analysis of patient-related risk factors for recurrence after inguinal hernia surgery has not been performed earlier .