Could long-term follow-up modify the outcomes after laparoscopic TAPP? A 5-year retrospective cohort study

• Published in: Hernia : the journal of hernias and abdominal wall surgery Vol. 23; no. 4; pp. 693 - 698
• Main Authors: Peña, M. E., Dreifuss, N. H., Schlottmann, F., Sadava, E. E.
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01-08-2019; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Aged; Cohort analysis; Female; Follow-Up Studies; Hernia; Hernia, Inguinal - surgery; Herniorrhaphy; Humans; Laparoscopy; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate analysis; Original Article; Pain; Postoperative period; Quality of Life; Recurrence; Retrospective Studies; Risk factors; Smoking; Statistical analysis; Surgical Mesh; Time Factors; Treatment Outcome; Laparoscopic inguinal hernia; Recurrence; Risk factors; Quality of life
• ISSN: 1265-4906; 1248-9204
• DOI: 10.1007/s10029-019-01953-5

Purpose
Laparoscopic inguinal hernia repair (LIHR) has demonstrated multiple benefits. However, long-term results regarding recurrence and quality of life (QoL) are still on debate. We aimed to analyze postoperative outcomes with long-term follow-up after LIHR.
Methods
A consecutive series from December 2012 to May 2017 of laparoscopic TAPP was included. A minimum of 6 months of follow-up was required for inclusion. The sample was divided into two groups, G1: patients with recurrence and G2: patients without recurrence. Patient’s characteristics, operative variables and postoperative outcomes were analyzed. A QoL survey (Eura-HS QoL) was performed in the pre- and postoperative period.
Results
A total of 717 laparoscopic TAPP were performed in 443 patients. On univariate analysis, smoking, previous recurrence, mesh size smaller than 12 × 15 cm and surgical teams with less than 30 cases/year showed an increased recurrence rate (
p
 < 0.05). But only smoking and less experienced teams were statistically significant on multivariate analysis (
p
 < 0.01). After a 2-year follow-up, recurrence rate was 1.5%, while it increased to 2.6% (
n
 = 19) at 5-year follow-up. Sixty percent of patients answered QoL survey. Average preoperative scores of pain, activities restriction and aesthetic dissatisfaction improved significantly after 6 months of follow-up in patients without recurrence.
Conclusions
After LIHR, quality of life shows a significant improvement in all parameters. Extending follow-up beyond 2 years after laparoscopic TAPP allows a more accurate assessment of recurrence rate. Smoking and inexperienced teams were significant risk factors for its development.