Similar Outcomes in Male and Female Patients Undergoing Elective Totally Extra-peritoneal Laparoscopic Inguinal Hernia Repair

Tyler Hall¹, Beau Forester¹, Lava Patel, MD¹, Matt Gitelis¹, Brittany Lapin, PhD¹, Michelle Leong¹, Zeeshan Butt, PhD², John G Linn, MD¹, Stephen P Haggerty, MD, FACS¹, Woody Denham, MD¹, Michael Ujiki, MD, FACS¹. ¹NorthShore University HealthSystem, ²Northwestern University Feinberg School of Medicine

Objective: Female gender has been found to increase risk of unfavorable postoperative outcomes following repair of various hernia types. Studies suggest that females experience higher risks of recurrence following incisional hernia repair and are at risk for increased pain, discomfort, and fatigue following laparoscopic transabdominal preperitoneal (TAPP) repair of groin hernias. However, limited data exist comparing female and male outcomes following totally extra-peritoneal (TEP) laparoscopic inguinal hernia repair (LIHR). The aim of our study was to compare quality of life trends and clinical outcomes following elective LIHR in male and female cohorts. We hypothesize that no significantly divergent outcomes would be found between the genders.

Methods: A retrospective review of a prospectively maintained database identified 588 male and 50 female patients who underwent LIHR between 2009 – 2015 (n=638). All cases were performed by four surgeons at a single institution, using totally extra-peritoneal (TEP) technique. Quality of life outcomes were measured using Short Form-36 (SF-36), Surgical Outcomes Measurement System (SOMS), and Carolinas Comfort Scale (CCS) surveys administered pre-operatively and at 3 weeks, 6 months, 1 year, and 2 years post- operatively. Comparisons between gender cohorts were made using a chi-square test or t-test. Changes over time were assessed using mixed effects models.

Results: A cohort of 638 patients underwent elective LIHR and completed a validated quality of life survey.

The female cohort contained a larger percentage of femoral hernias (8.0% vs. 2.0%, p=0.03), a smaller number recurrent hernias (2.0% vs. 13.3%, p=0.02), and a smaller number of previous, unrelated hernia repairs (8.3% vs. 27.8%, p<0.01). Additionally, the female cohort had significantly lower average BMI and BMI category composition (Table 1). There were no significant differences in postoperative complications, including recurrence rates (F=0.0% vs. M=2.1%, p=0.61) and readmission rates within 30 days (2.3% vs. 2.1%, p=0.99). Likewise, CCS scores for pain, mesh sensation, and movement did not differ at any time point. SOMS scores for pain, pain impact, pain quality, fatigue, physical functioning, body image, and satisfaction were also similar between groups.

Conclusion: Female gender was not found to be a risk factor for postoperative complications following laparoscopic repair of inguinal hernias using TEP technique. The two cohorts did not exhibit divergent clinical outcomes and no significant differences in short- or long-term quality of life were found.