No difference in genitourinary complications after laparoscopic vs. open groin hernia repair in women: a nationwide linked register-based cohort study

Background: During laparoscopic groin hernia repair, the surgeon may transect the round ligament of uterus to facilitate mesh placement. Transection during open repair is rarer and anatomically further from the uterus. Our aim was to compare long-term genitourinary outcomes, particularly genital prolapse, between open and laparoscopic repair in women with a primary groin hernia. Methods: The study was reported according to RECORD guidelines. All women having received a primary anterior open or laparoscopic groin hernia repair from 1998 to 2014 were identified through The Danish Hernia Database and linked with data from The Danish National Patient Registry and the Danish Register of Causes of Death. Our outcome was postoperative genital prolapse and other long-term complications related to gynecology, urology, and infertility. Results: We included 10,867 women having received a primary groin hernia repair, 7732 (71%) had an open anterior repair and 3135 (29%) a laparoscopic repair. The median (range) age was 59 (19–102) and 64 (18–105), respectively (p < 0.001). Median follow-up was 65 (range 0–203) months. After open repair, 313/7340 (4.2%) had a postoperative genital prolapse, and 46/2,934 (1.5%) after laparoscopic repair (p < 0.001). In multivariate Cox Regression analyses adjusting for age and hernia type, there were no difference between the two methods (p = 0.474). Women with an inguinal hernia had a higher risk of genital prolapse than women with a femoral hernia, independent of repair method [HR = 1.455 (1.143–1.853), p = 0.002]. We found no significant differences between open and laparoscopic methods in multivariate analyses assessing other long-term postoperative genitourinary and/or infertility outcomes. Conclusion: We found no differences in postoperative genital prolapse or other complications related to gynecology, urology, and/or infertility between open anterior and laparoscopic groin hernia repair in women. Assuming the round ligament of uterus is being transected more often in laparoscopic repair than in open, the urogenital consequences of transection seem to be minimal.