title: Endoscopic repair of primary versus recurrent male unilateral inguinal hernias: Are there differences in the outcome?
abstract: BACKGROUND
  To date, there are no prospective randomized studies that compare the outcome of endoscopic repair of primary versus recurrent inguinal hernias. It is therefore now attempted to answer that key question on the basis of registry data.
  
  
  METHODS
  In total, 20,624 patients were enrolled between September 1, 2009, and April 31, 2013. Of these patients, 18,142 (88.0%) had a primary and 2482 (12.0%) had a recurrent endoscopic repair. Only patients with male unilateral inguinal hernia and with a 1-year follow-up were included. The dependent variables were intra- and postoperative complications, reoperations, recurrence, and chronic pain rates. The results of unadjusted analyses were verified via multivariable analyses.
  
  
  RESULTS
  Unadjusted analysis did not reveal any significant differences in the intraoperative complications (1.28 vs 1.33%; p = 0.849); however, there were significant differences in the postoperative complications (3.20 vs 4.03%; p = 0.036), the reoperation rate due to complications (0.84 vs 1.33%; p = 0.023), pain at rest (4.08 vs 6.16%; p < 0.001), pain on exertion (8.03 vs 11.44%; p < 0.001), chronic pain requiring treatment (2.31 vs 3.83%; p < 0.001), and the recurrence rates (0.94 vs 1.45%; p = 0.0023). Multivariable analysis confirmed the significant impact of endoscopic repair of recurrent hernia on the outcome.
  
  
  CONCLUSIONS
  Comparison of perioperative and 1-year outcome for endoscopic repair of primary versus recurrent male unilateral inguinal hernia showed significant differences to the disadvantage of the recurrent operation. Therefore, endoscopic repair of recurrent inguinal hernias calls for particular competence on the part of the hernia surgeon.
authors.affiliation: Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany. ferdinand.koeckerling@vivantes.de.
authors.forename: F
authors.initials: F
authors.lastname: Köckerling
authors.affiliation: Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Jacob
authors.affiliation: Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Wiegank
authors.affiliation: StatConsult GmbH, Halberstädter Strasse 40 a, 39112, Magdeburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Hukauf
authors.affiliation: Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Schug-Pass
authors.affiliation: Department of General and Visceral Surgery, German Red Cross Hospital, Lützerodestrasse 1, 30161, Hannover, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Kuthe
authors.affiliation: Hernia Center, Winghofer Medicum, Winghofer Strasse 42, 72108, Rottenburg am Neckar, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Bittner
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D004724:Endoscopy; D005858:Germany / Q000453:epidemiology; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010146:Pain / Q000453:epidemiology / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology* / Q000601:surgery; D012008:Recurrence; D012042:Registries; D012086:Reoperation / Q000706:statistics & numerical data
keywords: Complications; Inguinal hernia; Recurrent; TAPP; TEP