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Female ‘groin’ hernia: totally extraperitoneal (TEP) endoscopic repair seems the most appropriate treatment modality

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Abstract

Background

About 30% of all female ‘groin’ hernias are femoral hernias, although often only diagnosed during surgery. A Lichtenstein repair though, as preferred treatment modality according to guidelines, would not diagnose and treat femoral hernias. Totally extraperitoneal (TEP) hernia repair, however, offers the advantage of being an appropriate modality for the diagnosis and subsequent treatment of both inguinal and femoral hernias. TEP therefore seems an appealing surgical technique for women with groin hernias.

Methods

This study included all female patients ≥18 years operated for a groin hernia between 2005 and 2009.

Results

A total of 183 groin hernias were repaired in 164 women. TEP was performed in 85% of women; the other 24 women underwent an open anterior (mesh) repair. Peroperatively, femoral hernias were observed in 23% of patients with primary hernias and 35% of patients with recurrent hernias. There were 30 cases (18.3%) of an incorrect preoperative diagnosis. Peroperatively, femoral hernias were observed in 17.3% of women who were diagnosed with an inguinal hernia before surgery. In addition, inguinal hernias were found in 24.0% of women who were diagnosed with a femoral hernia preoperatively. After a follow-up of 25 months, moderate to severe (VAS 4-10) postoperative pain was reported by 8 of 125 patients (6.4%) after TEP and 5 of 23 patients (21.7%) after open hernia repair (P = 0.03). Five patients had a recurrent hernia, two following TEP (1.4%) and three following open anterior repair (12.5%, P = 0.02). Two of these three patients presented with a femoral recurrence after a previous repair of an inguinal hernia.

Conclusion

Femoral hernias are common in women with groin hernias, but not always detected preoperatively; this argues for the use of a preperitoneal approach. TEP hernia repair combines the advantage of a peroperative diagnosis and subsequent appropriate treatment with the known good clinical outcomes.

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Acknowledgments

The authors thank Ms. J. E. Westendorp and Mrs. J. van der Laan, medical secretaries at our institution, for collecting and processing of the data. All authors hereby confirm that a Research Grant has been assigned to the Diakonnessenhuis Utrecht/Zeist, or more specifically to the Hernia Centre Zeist, by Johnson & Johnson. The Research Grant is intended to support all manuscripts regarding the results and complications of the totally extraperitoneal (TEP) endoscopic hernia repair.

Conflict of interest

This study itself is not directly subject of the Research Grant. Johnson & Johnson has and will have no access to data upon which the manuscript is based. A copy of the manuscript will only be provided at acceptance of the manuscript. Johnson & Johnson has no influence on (subject of) this study whatsoever. Objectivity of data is therefore guaranteed, and there is no conflict of interest. There are no (other) commercial associations that might pose a conflict of interest in connection with the submitted article.

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Authors and Affiliations

  1. Department of Surgery/Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands

    N. Schouten, J. P. J. Burgmans, T. van Dalen, N. Smakman, G. J. Clevers, P. H. P. Davids & E. J. M. M. Verleisdonk

  2. Centre for Health Sciences and Primary Care Centre, University Medical Centre (UMC) Utrecht, Utrecht, The Netherlands

    S. G. Elias

  3. Department of Surgery, University Medical Centre (UMC) Utrecht, Utrecht, The Netherlands

    R. K. J. Simmermacher

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  1. N. Schouten
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  2. J. P. J. Burgmans
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  3. T. van Dalen
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  4. N. Smakman
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  5. G. J. Clevers
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  6. P. H. P. Davids
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  7. E. J. M. M. Verleisdonk
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  8. S. G. Elias
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  9. R. K. J. Simmermacher
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Correspondence to N. Schouten.

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Schouten, N., Burgmans, J.P.J., van Dalen, T. et al. Female ‘groin’ hernia: totally extraperitoneal (TEP) endoscopic repair seems the most appropriate treatment modality. Hernia 16, 387–392 (2012). https://doi.org/10.1007/s10029-012-0904-7

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  • DOI: https://doi.org/10.1007/s10029-012-0904-7

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