Overview of complications of inguinal and femoral hernia repair
- David C Brooks, MD
David C Brooks, MD
- Associate Professor of Surgery
- Harvard Medical School
- Section Editors
- Michael Rosen, MD
Michael Rosen, MD
- Section Editor — Hernia Surgery
- Professor of Surgery
- Cleveland Clinic Foundation
- Jerome P Richie, MD, FACS
Jerome P Richie, MD, FACS
- Section Editor — Cancer of the Urethra, Penis, and Ureter; Urologic Surgery; Prostate Cancer
- Elliott Carr Cutler Professor of Surgery
- Harvard Medical School
Complications after inguinal or femoral hernia repair are relatively common. The incidence is higher after emergent repairs and recurrent hernia repairs compared with elective repair. With the transition to tension-free repair, hernia recurrence is less frequent while other complications, such as post-herniorrhaphy neuralgia, have become more prominent.
Complications that occur in the perioperative period include wound seroma/hematoma, urinary retention, bladder injury, and superficial wound infection, while complications that occur later following hernia repair include persistent groin pain and post-herniorrhaphy neuralgia, testicular complications, deep wound/mesh infection, recurrent hernia, and mesh migration and erosion.
Complications associated with inguinal and femoral hernia repair will be reviewed here. The operative techniques for inguinal and femoral hernia repair, including methods to prevent complications related to repair, are reviewed elsewhere. (See "Open surgical repair of inguinal and femoral hernia in adults" and "Laparoscopic inguinal and femoral hernia repair in adults".)
Complications after inguinal or femoral hernia repair are relatively common, with the incidence depending upon the clinical circumstance under which the repair was performed as well as the site and type of the hernia .
Urgent and emergent procedures are associated with higher complication rates compared with elective repair [2,3]. In one review of 1034 groin hernia repairs, overall complication rates were 27 percent for acute hernia repairs and 15.1 percent for elective repairs . Higher complication rates are also seen with repair of recurrent hernia compared with primary hernia repair. In studies comparing open and laparoscopic repair, the overall incidence of complications is similar; however, the nature of the complications differs. Identifiable differences are discussed below. (See "Overview of treatment for inguinal and femoral hernia in adults", section on 'Primary hernia'.)
- Matthews RD, Anthony T, Kim LT, et al. Factors associated with postoperative complications and hernia recurrence for patients undergoing inguinal hernia repair: a report from the VA Cooperative Hernia Study Group. Am J Surg 2007; 194:611.
- Koch A, Edwards A, Haapaniemi S, et al. Prospective evaluation of 6895 groin hernia repairs in women. Br J Surg 2005; 92:1553.
- Abi-Haidar Y, Sanchez V, Itani KM. Risk factors and outcomes of acute versus elective groin hernia surgery. J Am Coll Surg 2011; 213:363.
- Fitzgibbons RJ Jr, Giobbie-Hurder A, Gibbs JO, et al. Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial. JAMA 2006; 295:285.
- Hawn MT, Itani KM, Giobbie-Hurder A, et al. Patient-reported outcomes after inguinal herniorrhaphy. Surgery 2006; 140:198.
- Falagas ME, Kasiakou SK. Mesh-related infections after hernia repair surgery. Clin Microbiol Infect 2005; 11:3.
- Kocot A, Gerharz EW, Riedmiller H. Urological complications of laparoscopic inguinal hernia repair: a case series. Hernia 2011; 15:583.
- Gulino G, Antonucci M, Palermo G, et al. Urological complications following inguinal hernioplasty. Arch Ital Urol Androl 2012; 84:105.
- Köckerling F, Jacob DA, Bittner R, et al. Risk of postoperative urinary retention after laparoscopic (TAPP) or endoscopic (TEP) inguinal hernia repair. Surg Endosc 2013; 27:1049.
- Bittner R, Schmedt CG, Schwarz J, et al. Laparoscopic transperitoneal procedure for routine repair of groin hernia. Br J Surg 2002; 89:1062.
- Winslow ER, Quasebarth M, Brunt LM. Perioperative outcomes and complications of open vs laparoscopic extraperitoneal inguinal hernia repair in a mature surgical practice. Surg Endosc 2004; 18:221.
- Inaba T, Okinaga K, Fukushima R, et al. Chronic pain and discomfort after inguinal hernia repair. Surg Today 2012; 42:825.
- Schmedt CG, Sauerland S, Bittner R. Comparison of endoscopic procedures vs Lichtenstein and other open mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Surg Endosc 2005; 19:188.
- Schwab JR et al. After 10 years and 1.903 inguinal hernias, what is the outcome for the laparoscopic repair? Surgical Endoscopy. 2002;16:1201.
- Matthews R, Anthony T, Kim LT, Wang J, Fitzgibbon R, Giobbie-Hurder A, Reda D, Itani K, Neumayer L. Factors associated with postoperative complications and hernia recurrence for patients undergoing inguinal hernia repair. The American Journal of Surgery. 2007;194:611.
- Berney CR. Risk of postoperative urinary retention after laparoscopic (TAPP) or endoscopic (TEP) inguinal hernia repair. Surg Endosc 2013; 27:694.
- Kaul A, Hutfless S, Le H, et al. Staple versus fibrin glue fixation in laparoscopic total extraperitoneal repair of inguinal hernia: a systematic review and meta-analysis. Surg Endosc 2012; 26:1269.
- Tam KW, Liang HH, Chai CY. Outcomes of staple fixation of mesh versus nonfixation in laparoscopic total extraperitoneal inguinal repair: a meta-analysis of randomized controlled trials. World J Surg 2010; 34:3065.
- Garg P, Rajagopal M, Varghese V, Ismail M. Laparoscopic total extraperitoneal inguinal hernia repair with nonfixation of the mesh for 1,692 hernias. Surg Endosc 2009; 23:1241.
- Garg P, Nair S, Shereef M, et al. Mesh fixation compared to nonfixation in total extraperitoneal inguinal hernia repair: a randomized controlled trial in a rural center in India. Surg Endosc 2011; 25:3300.
- Bittner R, Arregui ME, Bisgaard T, et al. Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia [International Endohernia Society (IEHS)]. Surg Endosc 2011; 25:2773.
- Doehn C, Fornara P, Miglietti G, Jocham D. Uraemia after laparoscopic bilateral hernia repair. Nephrol Dial Transplant 1998; 13:1265.
- Schwab JR, Beaird DA, Ramshaw BJ, et al. After 10 years and 1903 inguinal hernias, what is the outcome for the laparoscopic repair? Surg Endosc 2002; 16:1201.
- Sanchez-Manuel FJ, Seco-Gil JL. Antibiotic prophylaxis for hernia repair. Cochrane Database Syst Rev 2003; :CD003769.
- Sanabria A, Domínguez LC, Valdivieso E, Gómez G. Prophylactic antibiotics for mesh inguinal hernioplasty: a meta-analysis. Ann Surg 2007; 245:392.
- Gilbert AI, Felton LL. Infection in inguinal hernia repair considering biomaterials and antibiotics. Surg Gynecol Obstet 1993; 177:126.
- Alfieri S, Amid PK, Campanelli G, et al. International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery. Hernia 2011; 15:239.
- Eklund A, Rudberg C, Smedberg S, et al. Short-term results of a randomized clinical trial comparing Lichtenstein open repair with totally extraperitoneal laparoscopic inguinal hernia repair. Br J Surg 2006; 93:1060.
- Grant AM, Scott NW, O'Dwyer PJ, MRC Laparoscopic Groin Hernia Trial Group. Five-year follow-up of a randomized trial to assess pain and numbness after laparoscopic or open repair of groin hernia. Br J Surg 2004; 91:1570.
- Shin D, Lipshultz LI, Goldstein M, et al. Herniorrhaphy with polypropylene mesh causing inguinal vasal obstruction: a preventable cause of obstructive azoospermia. Ann Surg 2005; 241:553.
- Delikoukos S, Tzovaras G, Liakou P, et al. Late-onset deep mesh infection after inguinal hernia repair. Hernia 2007; 11:15.
- Moon V, Chaudry GA, Choy C, Ferzli GS. Mesh infection in the era of laparoscopy. J Laparoendosc Adv Surg Tech A 2004; 14:349.
- Neumayer L, Giobbie-Hurder A, Jonasson O, et al. Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 2004; 350:1819.
- Costerton JW, Stewart PS, Greenberg EP. Bacterial biofilms: a common cause of persistent infections. Science 1999; 284:1318.
- Donlan RM. Biofilm formation: a clinically relevant microbiological process. Clin Infect Dis 2001; 33:1387.
- Vuong C, Gerke C, Somerville GA, et al. Quorum-sensing control of biofilm factors in Staphylococcus epidermidis. J Infect Dis 2003; 188:706.
- Taylor SG, O'Dwyer PJ. Chronic groin sepsis following tension-free inguinal hernioplasty. Br J Surg 1999; 86:562.
- Nolla-Salas J, Torres-Rodríguez JM, Grau S, et al. Successful treatment with liposomal amphotericin B of an intraabdomianl abscess due to Candida norvegensis associated with a Gore-Tex mesh infection. Scand J Infect Dis 2000; 32:560.
- Matthews MR, Caruso DM, Tsujimura RB, et al. Ventral hernia synthetic mesh repair infected by Mycobacterium fortuitum. Am Surg 1999; 65:1035.
- Deysine M. Pathophysiology, prevention, and management of prosthetic infections in hernia surgery. Surg Clin North Am 1998; 78:1105.
- Kuo YC, Mondschein JI, Soulen MC, et al. Drainage of collections associated with hernia mesh: is it worthwhile? J Vasc Interv Radiol 2010; 21:362.
- Cingi A, Manukyan MN, Güllüoğlu BM, et al. Use of resterilized polypropylene mesh in inguinal hernia repair: a prospective, randomized study. J Am Coll Surg 2005; 201:834.
- Terzi C, Kiliç D, Unek T, et al. Single-dose oral ciprofloxacin compared with single-dose intravenous cefazolin for prophylaxis in inguinal hernia repair: a controlled randomized clinical study. J Hosp Infect 2005; 60:340.
- Rehman S, Khan S, Pervaiz A, Perry EP. Recurrence of inguinal herniae following removal of infected prosthetic meshes: a review of the literature. Hernia 2012; 16:123.
- Salvati EA, Chekofsky KM, Brause BD, Wilson PD Jr. Reimplantation in infection: a 12-year experience. Clin Orthop Relat Res 1982; :62.
- Agrawal A, Avill R. Mesh migration following repair of inguinal hernia: a case report and review of literature. Hernia 2006; 10:79.
- PERIOPERATIVE COMPLICATIONS
- Urinary retention
- Bladder injury
- Superficial wound infection
- LATER COMPLICATIONS
- Persistent groin pain and post-herniorraphy neuralgia
- Testicular complications
- Deep wound/mesh infection
- Recurrent hernia
- Mesh migration and erosion
- SUMMARY AND RECOMMENDATIONS