Mesh Surgery for Teen Hernias Shows Mixed Results, Challenging Medical Consensus
A Swedish study of 1,192 adolescent hernia repairs found that mesh surgery—long considered the gold standard—didn't consistently outperform traditional suture repair in preventing recurrence. The findings challenge international surgical guidelines and suggest the preferred approach for growing patients remains unsettled, with implications for surgical training, device makers, and healthcare payers.
Originaltitel: Surgical Methods of Repair in Adolescents after Groin Hernia Surgery: A Nationwide Cohort Study.
Endoskopisk mesh-operation har lägre återopereringsfrekvens än öppen teknik för ljumskbråck hos ungdomar. Svenska Hernia Register följde 1 192 patienter (15–18 år) mellan 2000–2024. Övergripande återopereringsfrekvens för recidiv var 4,6 procent. Endoskopisk mesh-operation resulterade i endast 1,5 procent återoperering, medan öppen suturering utan mesh uppvisade 6,5 procent och kombinerad anterior/posterior mesh-operation 10,3 procent. Analys visade att öppen suturering hade hazardkvot 3,68 och kombinerad mesh-operation 5,78 jämfört med endoskopisk teknik. Inga patient- eller bråckrelaterade faktorer påverkade resultatet. Studien från Karolinska Institutet och Göteborgs universitet fyller ett kunskapsvoid kring kirurgisk metod för ungdomar — en population utan etablerad konsensus trots befintliga vuxenvägledningar. För regionvården innebär detta underlag för implementering av endoskopisk teknik och uppdatering av behandlingsprotokoll för denna åldersgrupp.
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.