COMMENTARY

Laparoscopic Is Best for Inguinal Hernia Repair in Females

Albert B. Lowenfels, MD

Disclosures

February 12, 2019

What are the recurrence rates after laparoscopic versus open repair of primary inguinal hernia in women? In a recent review, published in JAMA Surgery,[1] the authors present a summary of findings from 55 studies on recurrent inguinal hernias in 43,870 women.

In 20 studies that described recurrences after laparoscopic repair, the crude recurrence rate was 1.2%, and none of the patients had a recurrent femoral hernia. After open surgery (37 studies), the crude recurrence rate was 2.4%, and 4.9% of patients required surgery for a femoral hernia.

Recurrence Rates Are Lower After Laparoscopic Repairs

This report points out the advantages of a laparoscopic approach when repairing inguinal hernias in females. First, the overall recurrence rate with laparoscopy was lower, and second, after laparoscopic repair, women did not return because of a femoral hernia. The reasonable conclusion is that, when open hernia is performed for an inguinal hernia in females, sometimes the real culprit may be a femoral hernia that was overlooked or misdiagnosed at the first operation.

The results of this review support guidelines of the European Hernia Society that laparoscopic surgery is the preferred approach for repairing female inguinal hernias.[2]

How does the frequency of recurrence of inguinal hernias compare in males and females? In a recent report based on Medicare patients, recurrent hernias were twice as frequent in males than in females.[3]

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