Surgical Methods of Repair in Adolescents after Groin Hernia Surgery

Objective: To investigate surgical methods of repair’s impact on reoperation for recurrence in adolescents undergoing groin hernia surgery. Background: Despite established international guidelines for groin hernia repairs in adults, no current consensus exists regarding the preferred surgical method for adolescents. Proponents claim mesh is superior in preventing recurrence, while critics highlight potential risks for growing individuals. Investigating repair methods is an important step in improving patient outcomes in this population. Methods: This is a nationwide, population-based observational cohort study with prospectively collected data from the Swedish Hernia Register of adolescents undergoing groin hernia repair between 2000-2022 with follow-up until 2024. Patients aged 15-18 year were included. Primary outcome was reoperation for recurrence. Secondary objective was other risk-factors associated with reoperation for recurrence. Results: Totally 1,192 adolescent repairs were analysed, predominantly involving indirect hernias (90.5%) and male repairs (84.6%). Overall reoperation rate for recurrence were 4.6%, higher in open anterior mesh repairs (3.3%), open tissue suture repairs (6.5%), and open combined anterior/posterior mesh repairs (10.3%) compared to endo-laparoscopic mesh repairs (1.5%). Multivariable analysis revealed a significantly increased hazard ratio of 3.68 (95% CI 1.13-12.02) for open tissue suture repair and 5.78 (95% CI 1.35-24.74) for open combined anterior/posterior mesh repair compared to endo-laparoscopic mesh repairs. No patient or hernia-related variables were identified as significant risk-factors for reoperation for recurrence. Conclusion: The overall reoperation rate for recurrence was generally favorable across all techniques, with endo-laparoscopic mesh repairs associated with a lower risk, which may offer an advantage in preventing recurrences in adolescents undergoing groin hernia surgery.