title: Low reoperation rates in young males after sutured repair of indirect inguinal hernia: Arguments for a tailored approach.
abstract: 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 Database which is recording prospectively. 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.
authors.affiliation: Department of Surgery, Herlev Hospital, University of Copenhagen, Denmark. Electronic address: emil.haastrup.pedersen.02@regionh.dk.
authors.forename: Emil
authors.initials: E
authors.lastname: Haastrup
authors.affiliation: Department of Surgery, Herlev Hospital, University of Copenhagen, Denmark.
authors.forename: Kristoffer
authors.initials: K
authors.lastname: Andresen
authors.affiliation: Department of Surgery, Herlev Hospital, University of Copenhagen, Denmark.
authors.forename: Jacob
authors.initials: J
authors.lastname: Rosenberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006552:Hernia, Inguinal / Q000473:pathology / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data*; D013536:Suture Techniques; D055815:Young Adult
keywords: Hernia; Inguinal; Recurrence; Reoperation; Young males