Femoral vs Inguinal Hernia Repair: Long-term Clinical and Quality of Life (QOL) Outcomes From a Prospective, International Database

Joel F Bradley III, MD, K B Williams, MD, B A Wormer, MD, A L Walters, MS, K T Dacey, MHA, B T Heniford, MD, V A Augenstein, MD. Carolinas Medical Center.

Introduction: While research devoted to QOL regarding inguinal hernia repair continues to grow, little effort has been invested in QOL outcomes of femoral hernia repair. Our aim was to compare differences in QOL between femoral (FH) and inguinal hernia (IH) repairs.

Methods: The International Hernia Mesh Registry, a prospective, multinational database, was queried for patients undergoing FH or IH repair from 2007-2013. Demographics, comorbidities, operative details, complications and QOL as measured by the Carolinas Comfort Scale (CCS) were captured. Stratified analysis was performed according to gender utilizing Chi-square, Fishers, and Wilcoxon-Mann-Whitney Tests where appropriate.

Results: In total, 73 femoral (41.1% male) and 2481 inguinal (93.5% male) hernias were identified. When comparing FH versus IH in women, cohorts revealed similar age, BMI, and comorbidities (all p>0.05), except hypertension was less frequent (9.3% vs 24.8%; p=0.04) and smoking was more common in FH (29.3% vs 11.7%; p=0.005). Women with FH also had more recurrent repairs (18.6% vs 7.3%; p=0.04) and were more likely incarcerated (18.6% vs 4.8%; p=0.003). In men, there were no differences between FH and IH for age, BMI, or comorbidities. Comparing FH to IH (Table), both men and women had similar rates of preoperative pain and movement limitations, operative anesthetic type, bilateral repairs, rates of open, TAPP, and TEP repairs, types of mesh fixation, and operative times. Follow up at 1, 6, 12, 24 months was excellent: 92%, 73%, 82%, and 76%, respectively. Complications and recurrence were similar for FH vs IH for both groups, as well as CCS scores for pain, movement limitation, and mesh sensation at all follow-up time points (all p>0.05).

Conclusion: Femoral and inguinal hernia repair have similar long-term outcomes for men and women in regards to complications, recurrence and QOL regardless of laparoscopic versus open repair, type of anesthesia, and patient comorbidities.

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