Differences in the outcomes of scrotal vs. lateral vs. medial inguinal hernias: a multivariable analysis of registry data

Hernia. 2020 Aug 3. doi: 10.1007/s10029-020-02281-9. Online ahead of print.

Abstract

Introduction: There are hardly any studies on the outcome of scrotal compared with medial and lateral inguinal hernias. Therefore, this present multivariable analysis of data from the Herniamed Registry compared the outcome of scrotal vs. lateral vs. medial inguinal hernias and explored the relationship between hernia localization and outcomes.

Methods: Included in the analysis were all primary elective unilateral inguinal hernias in men with scrotal, lateral or medial defect localization whose details had been entered into the Herniamed Registry by 712 participating institutions (status February 1, 2019). The relation of the hernia localization with the outcome parameters adjusted for pre-defined confounding patient- and procedure-related variables was analyzed via multivariable binary logistic models.

Results: Details of 98,321 patients were thus available for multivariable analysis. These related to 65,932 (67.1%) lateral, 29,697 (30.2%) medial and 2,710 (2.7%) scrotal inguinal hernias. Scrotal hernias were associated with higher patient age, higher BMI, higher ASA score, larger defect, more risk factors and more frequent use of Lichtenstein repair. On the other hand, scrotal hernias were associated less commonly with preoperative pain. Multivariable analysis revealed that scrotal hernias had a highly significantly unfavorable association with postoperative complications, complication-related reoperations and general complications. But scrotal hernias had a highly significantly favorable relation with the pain rates at 1-year follow-up. Medial hernias were the hernia type most often related with recurrence and also had an unfavorable association with the pain rates at 1-year follow-up.

Conclusion: Scrotal inguinal hernias demonstrated a very unfavorable relation with the postoperative complication rate, the rate of complication-related reoperations and the rate of general complications. But a very favorable association with chronic pain rates was identified at 1-year follow-up. Medial inguinal hernia had an unfavorable relation with the recurrence and pain rates.

Keywords: Inguinal hernia; Lateral inguinal hernia; Medial inguinal hernia; Outcomes; Scrotal hernia.