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Quality of life and outcomes for femoral hernia repair: does laparoscopy have an advantage?

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Abstract

Background

Due to their relative scarcity and to limit single-center bias, multi-center data are needed to study femoral hernias. The aim of this study was to evaluate outcomes and quality of life (QOL) following laparoscopic vs. open repair of femoral hernias.

Methods

The International Hernia Mesh Registry was queried for femoral hernia repairs. Laparoscopic vs. open techniques were assessed for outcomes and QOL, as quantified by the Carolinas Comfort Scale (CCS), preoperatively and at 1, 6, 12, and 24 months postoperatively. Outcomes were evaluated using the standard statistical analysis.

Results

A total of 80 femoral hernia repairs were performed in 73 patients: 37 laparoscopic and 43 open. There was no difference in mean age (54.7 ± 14.6 years), body mass index (24.2 ± 3.8 kg/m2), gender (60.3 % female), or comorbidities (p > 0.05). The hernias were recurrent in 21 % of the cases with an average of 1.23 ± 0.6 prior repairs (p > 0.1). Preoperative CCS scores were similar for both groups and indicated that 59.7 % of patients reported pain and 46.4 % had movement limitations (p > 0.05). Operative time was equivalent (47.2 ± 21.2 vs. 45.9 ± 14.8 min, p = 0.82). There was no difference in postoperative complications, with an overall 8.2 % abdominal wall complications rate (p > 0.05). The length of stay was shorter in the laparoscopic group (0.5 ± 0.6 vs. 1.3 ± 1.6 days, p = 0.02). Follow-up was somewhat longer in the open group (23.8 ± 10.2 vs. 17.3 ± 10.9 months, p = 0.02). There was one recurrence, which was in the laparoscopic group (3.1 vs. 0 %, p = 0.4). QOL outcomes at all time points demonstrated no difference for pain, movement limitation, or mesh sensation. Postoperative QOL scores improved for both groups when compared to preoperative scores.

Conclusion

In this prospective international multi-institution study of 80 femoral hernia repairs, no difference was found for operative times, long-term outcomes, or QOL in the treatment of femoral hernias when comparing laparoscopic vs. open techniques. After repair, QOL at all time-points postoperatively improved compared to QOL scores preoperatively for laparoscopic and open femoral hernia repair. While international data supports improved outcomes with laparoscopic approach for femoral hernia repair, no data had existed prior to this study on the difference of approach impacting QOL. In the setting where recurrence and complication rates are equal after femoral hernia repair for either approach, surgeons should perform the technique with which they are most confident, as the operative approach does not appear to change QOL outcomes after femoral hernia repair.

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Author information

Authors and Affiliations

  1. Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Laparoscopic and Advanced Surgery Program, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28204, USA

    T. C. Cox, C. R. Huntington, L. J. Blair, T. Prasad, B. T. Heniford & V. A. Augenstein

Authors
  1. T. C. Cox
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  2. C. R. Huntington
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  3. L. J. Blair
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  4. T. Prasad
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  5. B. T. Heniford
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  6. V. A. Augenstein
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Corresponding author

Correspondence to V. A. Augenstein.

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Conflict of interest

There are no conflicts of interest for any authors related to this work. BTH has W.L. Gore and Associates, Ethicon, Novadaq, Bard/Davol, and LifeCell Inc not related to this work. VAA has W.L. Gore and Associates, Ethicon, Novadaq, Bard/Davol, and LifeCell Inc not related to this work. TCC has no conflicts of interest related or unrelated to this work. CRH has no conflicts of interest related or unrelated to this work. LJB has no conflicts of interest related or unrelated to this work. TP has no conflicts of interest related or unrelated to this work.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Accepted for podium presentation at the 1st World Conference on Abdominal Wall Surgery, Milan, Italy, April 2015.

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Cox, T.C., Huntington, C.R., Blair, L.J. et al. Quality of life and outcomes for femoral hernia repair: does laparoscopy have an advantage?. Hernia 21, 79–88 (2017). https://doi.org/10.1007/s10029-016-1502-x

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  • DOI: https://doi.org/10.1007/s10029-016-1502-x

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