Recurrence and complications after laparoscopic inguinal hernia repair using a self-adherent mesh: a patient-reported follow-up study

BACKGROUND: Recurrence and postoperative pain are major concerns after laparoscopic surgery for inguinal hernia. Follow-up on all patients is difficult and time consuming for both the hospital and the patient. We conducted a patient-reported follow-up study to estimate the rate of recurrence and postoperative pain in our department.

METHOD: Patients undergoing the TAPP (TransAbdominal PrePeritoneal) procedure with a self-adherent mesh at Copenhagen University Hospital - North Zealand from 2016 to 2019 received an online survey about signs of recurrence, postoperative pain, and complications. Patients reporting signs of recurrence or pain were contacted and invited for a clinical examination if relevant. Forty-five randomly selected patients who did not report any symptoms of recurrence or pain were contacted by phone for validation.

RESULTS: 871 patients received a questionnaire, and 546 responded, leaving a response rate of 62.7%. Median follow-up time was 34 months (IQR 23-47). The self-reported recurrence rate was 8.1% (95% CI: 6.0-11.0%). On examination, recurrence was diagnosed in 2.4% (95% CI: 1.4-4.1%) of the patients. When including the patients with self-reported recurrence who did not accept the offer of clinical examination, the recurrence rate was 3.8% (95% CI: 2.5-5.8%). Four patients (0.7%, 95% CI: 0.2-2.0%) underwent herniotomy for recurrence. The rate of chronic postoperative pain impairing daily activity was 0.5%.

CONCLUSION: We found an acceptable low rate of recurrence and postoperative pain compared to other studies. The patient-reported recurrence rate was significantly higher than the clinical recurrence rate after the examination, indicating that patient-reported recurrence seems to overestimate true recurrence after TAPP.