Reoperation for Recurrence After Groin Hernia Repair in Adolescents: A Nationwide Register-Based Cohort Study.

Abstract

<h4>Background</h4>Although mesh-based repairs are used in adults to reduce the risk of recurrence, their necessity in adolescents remains debated. Nonmesh repairs are often preferred in younger patients to avoid potential long-term complications, but data on recurrence rates in this age group are limited. We aimed to assess the rate of reoperation for recurrence following primary groin hernia repair in adolescents aged 10-19 years.<h4>Methods</h4>This was a register-based cohort study covering three decades (1992-2022), utilizing data from the Danish National Patient Register linked to data from the Danish Civil Registration System, ensuring comprehensive nationwide coverage and complete follow-up. The cumulative rate of reoperation for recurrence was estimated at 10 years of follow-up. Cox proportional hazards regression analysis was used to compare the risk of reoperation for recurrence between mesh and nonmesh repairs. Outcomes included reoperation for recurrence, readmission, and mortality.<h4>Results</h4>Among the 2404 included groins, most were male (80%), and the median age was 16 (IQR, 12-19) years. Most (99%) groin hernias were inguinal, and few (1%) were femoral. Of the inguinal repairs, 35% were mesh, 64% were nonmesh, and 1% were unspecified repairs. The follow-up time was median 16 (IQR, 9-21) years. The cumulative rate of reoperation for recurrence across all inguinal repairs was 3.8% (95% CI, 3.0-4.9) after 10 years of follow-up. For older adolescents aged 15-19 years, the cumulative rate of reoperation for recurrence after mesh and nonmesh repair was 2.7% (95% CI, 1.6-4.6) and 4.1% (95% CI, 2.6-6.7), respectively. Nonmesh repair had a higher adjusted hazard ratio of reoperation for recurrence compared with mesh repair (adjusted hazard ratio, 2.11; 95% CI, 1.05-4.23). For femoral repairs, most (67% [18/27]) were open nonmesh repairs, and few were reoperated for recurrence.<h4>Conclusion</h4>The cumulative rate of reoperation for recurrence was low in adolescents. These findings suggest that nonmesh repair may be sufficient for primary groin hernia repair in adolescents, potentially avoiding the need for mesh implantation.