Laparoscopic Versus Open Inguinal Hernia Repair in Octogenarians: A Follow-Up Study

Kai B Dallas, BS, Dvir Froylich, MD, Jacqueline J Choi, MD, Jonatan Hernandez Rosa, BS, Christopher LO, BS, Modesto J Colon, MD, Dana T Telem, MD, Celia M Divino, MD. Mount Sinai School of Medicine

Introduction: Laparoscopic inguinal hernia repair is associated with decreased postoperative pain, chronic pain and recovery time in the general population. This repair modality, however, requires general anesthesia and bladder catheterization and therefore its applicability to the elderly population remains uncertain. This study evaluates the outcomes of open versus laparoscopic repair in octogenarians.
Methods: A retrospective review with prospective follow-up was performed on115 patients, age >80, who underwent inguinal hernia repair at a single institution from 2005-2008. Outcome measures included postoperative pain score, recovery time, chronic pain, wound infection, urinary retention, urinary tract infection (UTI), hematoma and recurrence. Patient satisfaction was assessed by the Likert score.
Results: Of the 115 repairs, 33 repairs were performed laparoscopically and 84 open. Mean patient age was 83.3 years (range 80-95 years) with no significant difference in mean age, gender proportion or follow up time between the two groups. Mean recovery time was significantly shorter in the laparoscopic group (7.5 vs. 23.1 days, p=0.02), as was the mean duration of pain in the laparoscopic group (9.6 vs. 1.4 days, p=0.04). There were no significant differences in severity of postoperative pain, wound infection, recurrence, chronic pain, UTI or hematoma. There was a trend towards increased patient satisfaction in the laparoscopic group (p=0.10).
Conclusions:
In octogenarians, laparoscopic inguinal hernia repair confers a significantly shorter duration of pain and recovery time as compared to open. No increase in postoperative complications or recurrence was demonstrated. For elderly patients, laparoscopy is a viable, if not preferred, alternative to open repair.