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Background Bilateral groin hernias comprise approximately 25% of all groin hernias, with one side often being asymptomatic/minimally symptomatic. With an increase in minimally invasive approaches, simultaneous bilateral groin hernia repair (B-GHR) is frequently performed in routine practice. However, chronic pain and recurrence remain significant postoperative concerns. This study evaluated long-term outcomes after B-GHR versus unilateral groin hernia repairs (U-GHR). Methods This nationwide population-based cohort study used prospective data from the Swedish Hernia Register, combined with a patient-reported outcome measure (PROM) questionnaire. All men and women aged ≥ 15 years with groin hernia repair registered between 1 September 2012 and 31 December 2018 were included in the study. Primary outcomes were chronic pain and patient dissatisfaction 1 year after B-GHR versus U-GHR. Secondary outcomes included reoperation for recurrence up until 2020, and risk factors for these long-term outcomes exclusively after B-GHR. Results In all, 65 749 patients provided PROM data for analysis (response rate 69.4%). Chronic pain at 1 year was reported by 16.2% of patients (27) after B-GHR and by 15.4% of patients (9232) after U-GHR. A higher proportion of women undergoing B-GHR reported increased chronic pain than men (23.0 versus 15.4%; P < 0.001). Multivariable regression analyses revealed a higher risk of chronic pain (odds ratio (OR) 1.14; P = 0.002) and patient dissatisfaction (OR 1.30; P < 0.001) after B-GHR than U-GHR. Female sex and age < 50 years were independent risk factors for chronic pain and patient dissatisfaction after B-GHR. No significant difference was observed in reoperation rates for recurrence. Conclusions B-GHR is associated with an increased risk of chronic pain and patient dissatisfaction compared with U-GHR. Women and younger patients are particularly at risk, suggesting a more cautious approach to simultaneous B-GHR in routine practice, especially in the absence of clear symptoms, and highlighting the importance of watchful waiting.

AIM: Femoral hernia is associated with a higher complication risk compared to inguinal hernia. Most groin hernia research studies today are performed on men. The Lichtenstein technique is a well-studied, safe, and widely used method in men, but not recommended in women, where the recommended approach is either endoscopic or an open preperitoneal technique.

MATERIALS AND METHODS: A case-control pilot study was performed on adult women with groin hernia repaired using a modified Lichtenstein (ML) technique. The technique is the same as the original Lichtenstein method, with the addition of an incision in the posterior wall of the inguinal canal. If a femoral hernia or weakening is found, a mesh flap is applied to cover the femoral orifice. The primary outcome was perioperative complications, and the secondary outcome was long-term complications.

RESULTS: In this pilot study, 48 women were operated with the ML technique. Only minor perioperative complications were seen, and no serious adverse events occurred. The complications were transient, and no unplanned hospital admission was necessary. No recurrent hernias occurred during the follow-up period, only a few women were dissatisfied with the procedure, and even less reported persisting pain.

CONCLUSION: This ML technique could be an alternative method for female groin hernia repair. This pilot study paves the way for further research and development of this method, which eventually could be used in resource-limited settings or where the surgeon is not specialized in hernia repair.

PURPOSE: Surgery for groin hernia is one of the most common operations in the world. Therefore, research concerning the outcomes of groin hernia surgery is extremely important both for the individual patient as well as for those providing the healthcare funding. The aim of this study is to evaluate the outcomes of hernia surgery in Sweden over a 30 year time period, from 1992 to 2021.

METHODS: All groin hernia repairs in the Swedish Hernia Register between 1992 to 2021 were analyzed with emphasis on the surgical method, reoperation rate for recurrence and date of surgery, specifically 1992-2001, 2002-2011 and 2012-2021. By using personal identification numbers, a cumulative reoperation rate has been deduced for males and females separately.

RESULTS: A total of 368,502 groin hernia operations identified in the Swedish Hernia Register between 1992 to 2021 were eligible for analysis. Since the register was begun, there have been significant changes in the choice of operative techniques, from suture repair in 1992 to open anterior mesh repair around the year 2000, until today, where an increasing proportion of hernias are repaired using laparo-endoscopic techniques. There has been a reduction in the reoperation rate for recurrence in both males and females, with the most pronounced improvement being seen in females. The laparo-endoscopic technique is associated with a reduced incidence of reoperation for recurrence in females.

CONCLUSION: Groin hernia surgery in Sweden has undergone substantial changes over the past 30 years. Reoperation for recurrence has decreased significantly during recent years, especially in females.

Purpose: The incidence of trocar site hernia (TSH) after bariatric surgery is unclear. This study aims to describe the cumulative incidence of ventral hernia surgery after laparoscopic bariatric surgery in total and by laparoscopic method (LRYGB; Roux-en-Y Gastric Bypass and LSG; Sleeve Gastrectomy).

Methods: This was a register based observational study on patients subjected to laparoscopic bariatric surgery (LRYGB or LSG) in Sweden 2009–2019. The Scandinavian Obesity Surgery Registry (SOReg) was linked to the Swedish National Patient Register (NPR) to obtain instances of ventral hernia surgery. Nearby codes were used as proxies for TSH surgery, since a specific procedure code for TSH surgery is lacking.

Results: In 64 124 patients, mean follow-up was 67 ± 36 months, LRYGB (n = 52 020) 74 ± 34 months and LSG (n = 12 104) 34 ± 22 months. Mean time between bariatric- and ventral hernia surgery was 36 ± 28 months (range 0–129). The five-year cumulative incidence of surgery for ventral hernia was 2.9% (CI 2.8–3.1). The probability of having hernia surgery was significantly higher for LRYGB compared to LSG (Breslow test, p < 0.001), still significant with differences in follow-up time accounted for (p < 0.001).

Conclusion: The incidence of surgery for ventral hernia after laparoscopic bariatric surgery is not negligible in this material covering over a decade of bariatric procedures. Ventral hernia surgery was more common after gastric bypass than after sleeve gastrectomy.

Background: Nowadays, groin hernia repair with mesh is a gold standard procedure in western countries. Yet, foreign body reaction and mesh infection are feared complications. This study aimed to investigate the prevalence and risk factors for mesh removal due to foreign body reaction and mesh infection after groin hernia repair.

Method: This is an observational nationwide population-based register study with the use of prospectively collected data from the Swedish Hernia Register. All patients 15 years or older with a groin hernia repair registered between 1992 and 2022 were eligible. The primary outcome was the prevalence of re-surgery with mesh removal. The secondary outcome was risk factors for re-surgery with mesh removal.

Results: Of 363,664 groin hernia repairs during this 30-year-long study period, 211 (0.06%) had a re-surgery with mesh removal. The proportion of female groin hernia repairs was higher in the mesh removal group (15.2%) compared with the nonmesh removal group (7.9%). The adjusted multivariable Cox regression analysis for the risk of re-surgery with mesh removal demonstrated significantly increased hazard ratios for female (2.80, confidence interval: 1.70–4.63), emergency (3.43, confidence interval: 1.94–6.03), open anterior mesh (2.76, confidence interval: 1.61–4.72), and combined anterior/posterior mesh (predominately mesh plugs) (3.98, confidence interval: 1.84–8.57) groin hernia repairs, and for patients below the total median of 63 years (2.61, confidence interval: 1.78–3.81).

Conclusion: The groin tissue's tolerance for an implanted mesh after a groin hernia repair can be considered high where re-surgery for mesh removal due to foreign body reaction and mesh infection is rare. Female sex, younger patients, emergency repairs, and mesh plugs were most evident associated risk factors for such re-surgery.

Importance: Most women in low- and middle-income countries lack access to laparoscopic methods for groin hernia repair; therefore, an open technique through which both inguinal and femoral hernias can be treated is needed. This could be an option in the absence or inability to use laparoscopic methods.

Objective: To determine the safety and effectiveness of open anterior mesh (OAM) repair compared with modified open anterior mesh (MOAM) repair, which includes opening the transversalis fascia and covering the femoral canal with a mesh flap.

Design, Setting, and Participants: This was a parallel, 2-arm, double-blind, randomized clinical trial conducted in Northern Uganda, in East Africa, at 2 public hospitals between October 2019 and February 2023. Included in the study were adult women 18 years and older with a primary groin hernia, American Society of Anesthesiologists (ASA) class I or II, and the ability to give informed consent.

Interventions: OAM in the control arm and MOAM in the intervention arm.

Main Outcomes and Measures: The primary outcome was groin hernia recurrence 1 year postoperatively.

Results: A total of 200 participants (mean [SD] age, 52.7 [14.0] years) were included in the study; 99 (49.5%) were allocated to OAM repair, and 101 (50.5%) were allocated to MOAM repair. Nearly 45% of the participants (89 of 200) had a femoral hernia; therefore, 35 of 99 participants (35.4%) in the control arm received the intervention procedure. One year postoperatively, the overall recurrence was 5.6% (11 of 195 participants), and the intention-to-treat analysis showed that 4 of 97 participants (4.1%) in the control arm and 7 of 98 participants (7.1%) in the intervention arm had recurrence (absolute difference = -3.0 percentage points; 95% CI, -9.5 to 3.4; P = .36).

Conclusions and Relevance: Results of this randomized clinical trial demonstrate that the MOAM repair was a good option for groin hernia repair in women in low-resource settings. Femoral hernias were very common in the study population, and exposure of the femoral canal was essential to detect these hernias.

BACKGROUND: Inguinal hernia repair is one of the most performed surgical procedures, but, nevertheless, there is a high unmet need, with over 200 million people worldwide living with an inguinal hernia. The aims of this study were to evaluate 5-year outcomes after anterior mesh inguinal hernia repair, to assess the safety of a training intervention, and to compare the outcomes of patients operated on by a medical doctor (MD) versus an associate clinician (AC).

METHODS: Adult men with a primary inguinal hernia were included either as training patients or in the randomized trial, with surgical treatment performed by an MD or an AC. Patients were followed up mostly at hospital or at home; questionnaire information was collected and physical examinations were performed. Outcomes of training and trial patients were compared and outcomes of patients who underwent surgeries performed by MDs or ACs during the trial were compared.

RESULTS: In total, 129 patients were included in the training group and 229 patients were included in the randomized trial group. At 5-year follow-up, 288 patients (80.4%) were alive, 40 patients (11.2%) had died, and 30 patients (8.4%) were lost to follow-up. The overall recurrence rate was 5.0% and the all-cause mortality rate was 11.2%. Mortality and recurrence were not significantly different between the training and trial patients or between the patients who underwent surgeries performed by MDs or ACs during the trial.

CONCLUSION: Long-term outcomes after primary elective inguinal mesh hernia repair indicate that hands-on short-course training can be implemented effectively and that task sharing is safe and effective.

Purpose: Annually, more than 24,000 groin hernia repairs are performed in Sweden and Denmark, approximately 12,000 of which are laparoscopic like totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) repairs. TEP is the preferred technique in Sweden, whereas TAPP is preferred in Denmark. This study aimed to assess the risk of reoperation for recurrence following TAPP, TEP, and Lichtenstein techniques.

Method: Prospectively collected data from the Danish Hernia Database and the Swedish Hernia Register were utilized for this observational register-based study. Primary groin hernia repairs utilizing TEP, TAPP, or Lichtenstein techniques between 2004 and 2020 were included. The primary outcome was the reoperation rate for recurrence analyzed using both crude reoperation rates and Cox proportional hazard regression analysis.

Results: During 17 years, 347,912 primary groin hernia repairs were performed, of which 12% were TEP, 15% TAPP, and 74% Lichtenstein repairs. In males, the risk of reoperation was higher after TEP than after TAPP (HR 1.38, 95% CI 1.27–1.5) and Lichtenstein (HR 1.44, 95% CI 1.36–1.53). In females, Lichtenstein repair had a higher risk than the laparoscopic approaches, with no significant difference between TAPP and TEP.

Conclusion: Our study demonstrated low rates of reoperation for recurrence after Lichtenstein, TEP, and TAPP repairs. In men, TEP repair is associated with an increased risk of reoperation for recurrence compared with Lichtenstein and TAPP repair. For females, the laparoscopic approaches were superior to the Lichtenstein repair. These findings emphasize the importance of international comparative studies to optimize hernia management strategies.

Background: Despite the global prevalence of groin hernia repairs, there is still limited understanding regarding the impact of surgical expertise on patient outcomes, particularly since a significant portion of hernia repairs worldwide are performed by junior surgeons. This study aims to evaluate the long-term outcomes of groin hernia repairs carried out by specialist compared to those performed by resident surgeons.

Material and Methods: This observational, nationwide, population-based registry study utilized prospectively collected data from the Swedish Hernia Register as well as patient-reported outcome measures (PROM) 1 year after groin hernia surgery. Included patients were aged 15 years or older who underwent groin hernia repair between 2012 and 2018. Surgical expertise was categorized as either specialist or resident surgeon. Primary outcome was dissatisfaction and chronic pain 1 year post-surgery. Secondary outcome was reoperation for recurrence with follow-up until 2024.

Results: In total, 62 033 groin hernia repairs were analyzed, with a response rate of 70% for PROM questionnaire. Moreover, 72% of surgeries were performed by specialists and 28% by resident surgeons. Multivariable analysis revealed no significant differences. In the specialist group, 5.7% reported dissatisfaction compared to 4.5% in the resident group (odds ratio [OR] 0.92, 95% confidence interval [CI] 0.84-1.02). Chronic pain was experienced by 15.4% of specialist operated patients and 15.5% of resident operated patients (OR 1.05, 95% CI 0.99-1.12). And 2.6% of patients in the specialist group underwent reoperation for recurrence, compared to 2.3% in the resident group (hazard ratio 0.97, 95% CI 0.86-1.11).

Conclusion: Groin hernia repairs represent a significant surgical procedure for resident surgeons in training. The level of surgical expertise was not found to be associated with increased long-term complications, suggesting that resident surgeons do not affect groin hernia patients negatively.

Introduction: The aim of this study was to evaluate the association between parity and the incidence rate of groin hernia repair in women.

Method: This study was based on two Swedish national registers, the Medical Birth Register (MBR), and the Swedish Hernia Register (SHR). The cohort constituted of women born between 1956 and 1983. Data on vaginal and cesarean deliveries were retrieved from the MBR. The birth and hernia registers were cross matched to identify hernia repairs carried out after deliveries.

Results: A total of 1,535,379 women were born between 1956 and 1983. Among these, 1,417,237 (92.3%) were registered for at least one birth. The incidence rate for Inguinal Hernia Repair (IHR) and Femoral Hernia Repair (FHR) was 10.7 per 100,000 person-year and 2.6 per 100,000 person-year, respectively. Compared with women registered for one delivery, the incidence rate ratio for IHR was 1.31 (95% Confidence Interval: 1.23–1.40) among women registered for two deliveries, 1.70 (1.58–1.82) among women registered for ≥ 3 deliveries. Additionally, the incidence rate ratios were higher 1.30 (1.14–1.49) and 1.70 (1.49–1.95) for FHR among women with two and ≥ 3 registered deliveries, respectively.

Conclusion: In the present cohort, higher parity was associated with a higher incidence of inguinal as well as FHRs.