{"id":{"repo_id":"lund","oai_identifier":"oai:lup.lub.lu.se:8a5338f7-f8c4-4257-bfbc-b623587cf9db"},"canonical_url":"https://search.dev.ndltd.org/etd/lund/oai:lup.lub.lu.se:8a5338f7-f8c4-4257-bfbc-b623587cf9db","repository":{"repo_id":"lund","name":"University of Lund","base_url":"https://lup.lub.lu.se/oai"},"display":{"title":"Recurrent groin hernia - Outcome after surgery","abstract":"Background: According to the Swedish Hernia Register (SHR), the reoperation rate after recurrent groin hernia is more than twice that following primary hernia repair. Aims: To study the impact of method of mesh repair used in recurrent groin hernia surgery on re-recurrence as well as chronic pain and physical disability. Methods: Papers 1 and 2 were based on nationwide data from the SHR 1992-2008. In Paper 1 the cumulative risk for reoperation was studied after repeated surgery for recurrent hernia. In Paper 2 the risk for reoperation was analysed in relation to the mesh method used for recurrent hernia repair, taking the previous (index) repair into account. Papers 3 and 4 were based on a cohort of 1st and 2nd recurrent repairs performed at 5 hospitals in the south-west region of Sweden 1998-2007. A follow-up was performed 2009 using the Inguinal Pain Questionnaire (IPQ) and a selective clinical examination. In Paper 3 the risk for a 2nd recurrence was studied in relation to Anterior (AMR) and Posterior Mesh Repairs (PMR) and in Paper 4 the hazard ratio for chronic pain and physical disability was studied in relation to type of mesh repair and mean surgeon´s annual volume. Results: Paper 1 The risk for a further reoperation increased with the number of recurrent repairs (p<0.001). Paper 2 Endoscopic (E-PMR) and open PMR (O-PMR) were associated with the lowest risk for reoperation when the index repair was an anterior repair (p<0.001) Paper 3. PMR was associated with a decreased 2nd recurrence rate compared with AMR (p=0.025). An increased risk for a subsequent 2nd recurrence was seen an after anterior index repair followed by an AMR (HR 3.21 (CI 1.33-7.44), p=0.009)) and a decreased risk after posterior index repair followed by an AMR (HR 0.08 (CI 0.01-0.94), p=0.045). In the O-PMR group there was a lower 2nd recurrence rate after a Nyhus approach (2.5 %) compared to a trans inguinal approach (TIPP) (28 %) (p=0.001). A mean surgeon´s annual volume ≤ 5 O-PMR resulted in a higher risk for a 2nd recurrence (p<0.001). Paper 4 The E-PMR was associated with a lower risk for chronic pain and physical disability compared to AMR, after a previous anterior index repair (OR 0.54 (CI 0.30-0.97), p=0.039). A mean surgeon´s annual volume > 5 O-PMR correlated with a lower risk for chronic pain compared to an surgeon´s annual volume ≤ 5 (OR 0.42 (CI 0.19-0.94), p=0.034). Having a 2nd recurrent repair was associated with a higher risk for chronic pain compared to a 1st recurrent repair (OR 2.89 (CI 1.21-6.88), p=0.017). Conclusions: A posterior mesh repair for recurrent groin hernia surgery was associated with a lower 2nd recurrence rate compared to anterior mesh repair. A posterior mesh repair for the 1st recurrent operation is recommended after an anterior index repair and an anterior mesh repair after a posterior index operation. Endoscopic repairs have the lowest risk for both a 2nd recurrence and chronic groin pain and physical disability. An O-PMR performed trough a Nyhus incision is preferred and the TIPP procedure should be avoided. An surgeon´s annual volume > 5 O-PMR resulted in a lower 2nd recurrence rate and a lower risk for chronic pain. The risk for further recurrence increases with increasing number of groin hernia operations and the risk for chronic pain increases after a 2nd recurrent repair.","abstract_html":"Background: According to the Swedish Hernia Register (SHR), the reoperation rate after recurrent groin hernia is more than twice that following primary hernia repair. Aims: To study the impact of method of mesh repair used in recurrent groin hernia surgery on re-recurrence as well as chronic pain and physical disability. Methods: Papers 1 and 2 were based on nationwide data from the SHR 1992-2008. In Paper 1 the cumulative risk for reoperation was studied after repeated surgery for recurrent hernia. In Paper 2 the risk for reoperation was analysed in relation to the mesh method used for recurrent hernia repair, taking the previous (index) repair into account. Papers 3 and 4 were based on a cohort of 1st and 2nd recurrent repairs performed at 5 hospitals in the south-west region of Sweden 1998-2007. A follow-up was performed 2009 using the Inguinal Pain Questionnaire (IPQ) and a selective clinical examination. In Paper 3 the risk for a 2nd recurrence was studied in relation to Anterior (AMR) and Posterior Mesh Repairs (PMR) and in Paper 4 the hazard ratio for chronic pain and physical disability was studied in relation to type of mesh repair and mean surgeon´s annual volume. Results: Paper 1 The risk for a further reoperation increased with the number of recurrent repairs (p&lt;0.001). Paper 2 Endoscopic (E-PMR) and open PMR (O-PMR) were associated with the lowest risk for reoperation when the index repair was an anterior repair (p&lt;0.001) Paper 3. PMR was associated with a decreased 2nd recurrence rate compared with AMR (p=0.025). An increased risk for a subsequent 2nd recurrence was seen an after anterior index repair followed by an AMR (HR 3.21 (CI 1.33-7.44), p=0.009)) and a decreased risk after posterior index repair followed by an AMR (HR 0.08 (CI 0.01-0.94), p=0.045). In the O-PMR group there was a lower 2nd recurrence rate after a Nyhus approach (2.5 %) compared to a trans inguinal approach (TIPP) (28 %) (p=0.001). A mean surgeon´s annual volume ≤ 5 O-PMR resulted in a higher risk for a 2nd recurrence (p&lt;0.001). Paper 4 The E-PMR was associated with a lower risk for chronic pain and physical disability compared to AMR, after a previous anterior index repair (OR 0.54 (CI 0.30-0.97), p=0.039). A mean surgeon´s annual volume &gt; 5 O-PMR correlated with a lower risk for chronic pain compared to an surgeon´s annual volume ≤ 5 (OR 0.42 (CI 0.19-0.94), p=0.034). Having a 2nd recurrent repair was associated with a higher risk for chronic pain compared to a 1st recurrent repair (OR 2.89 (CI 1.21-6.88), p=0.017). Conclusions: A posterior mesh repair for recurrent groin hernia surgery was associated with a lower 2nd recurrence rate compared to anterior mesh repair. A posterior mesh repair for the 1st recurrent operation is recommended after an anterior index repair and an anterior mesh repair after a posterior index operation. Endoscopic repairs have the lowest risk for both a 2nd recurrence and chronic groin pain and physical disability. An O-PMR performed trough a Nyhus incision is preferred and the TIPP procedure should be avoided. An surgeon´s annual volume &gt; 5 O-PMR resulted in a lower 2nd recurrence rate and a lower risk for chronic pain. The risk for further recurrence increases with increasing number of groin hernia operations and the risk for chronic pain increases after a 2nd recurrent repair.","abstract_has_math":false,"creators":["Sevonius, Dan"],"institution":"Surgery, Faculty of Medicine, Lund University","degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":[],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2014,"date_issued":"2014","date_published":"2014","updated_at":"2026-07-24T02:59:49Z","subjects":["Surgery","Groin hernia","inguinal hernia","recurrence","re-recurrence","mesh repair","chronic pain","hernia register"],"languages":["eng"],"rights":["info:eu-repo/semantics/openAccess"],"rights_urls":[],"identifier_entries":[{"key":"dc:identifier","label":"Identifier","values":["urn:isbn:978-91-7619-070-8"],"render_values":[{"text":"urn:isbn:978-91-7619-070-8","href":null,"code":true}]}]},"links":{"outbound_url":"https://lup.lub.lu.se/record/4778912","outbound_label":"Repository record","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:creator","label":"Author","values":["Sevonius, Dan"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date","label":"Dc Date","values":["2014"]},{"key":"dc:publisher","label":"Institution","values":["Surgery, Faculty of Medicine, Lund University"]},{"key":"dc:type","label":"Dc Type","values":["thesis/doccomp","info:eu-repo/semantics/doctoralThesis","text"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["Surgery","Groin hernia","inguinal hernia","recurrence","re-recurrence","mesh repair","chronic pain","hernia register"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language","label":"Dc Language","values":["eng"]},{"key":"dc:rights","label":"Dc Rights","values":["info:eu-repo/semantics/openAccess"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["https://lup.lub.lu.se/record/4778912","urn:isbn:978-91-7619-070-8","https://portal.research.lu.se/files/3914383/4778913.pdf"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description","label":"Description","values":["Background: According to the Swedish Hernia Register (SHR), the reoperation rate after recurrent groin hernia is more than twice that following primary hernia repair. Aims: To study the impact of method of mesh repair used in recurrent groin hernia surgery on re-recurrence as well as chronic pain and physical disability. Methods: Papers 1 and 2 were based on nationwide data from the SHR 1992-2008. In Paper 1 the cumulative risk for reoperation was studied after repeated surgery for recurrent hernia. In Paper 2 the risk for reoperation was analysed in relation to the mesh method used for recurrent hernia repair, taking the previous (index) repair into account. Papers 3 and 4 were based on a cohort of 1st and 2nd recurrent repairs performed at 5 hospitals in the south-west region of Sweden 1998-2007. A follow-up was performed 2009 using the Inguinal Pain Questionnaire (IPQ) and a selective clinical examination. In Paper 3 the risk for a 2nd recurrence was studied in relation to Anterior (AMR) and Posterior Mesh Repairs (PMR) and in Paper 4 the hazard ratio for chronic pain and physical disability was studied in relation to type of mesh repair and mean surgeon´s annual volume. Results: Paper 1 The risk for a further reoperation increased with the number of recurrent repairs (p<0.001). Paper 2 Endoscopic (E-PMR) and open PMR (O-PMR) were associated with the lowest risk for reoperation when the index repair was an anterior repair (p<0.001) Paper 3. PMR was associated with a decreased 2nd recurrence rate compared with AMR (p=0.025). An increased risk for a subsequent 2nd recurrence was seen an after anterior index repair followed by an AMR (HR 3.21 (CI 1.33-7.44), p=0.009)) and a decreased risk after posterior index repair followed by an AMR (HR 0.08 (CI 0.01-0.94), p=0.045). In the O-PMR group there was a lower 2nd recurrence rate after a Nyhus approach (2.5 %) compared to a trans inguinal approach (TIPP) (28 %) (p=0.001). A mean surgeon´s annual volume ≤ 5 O-PMR resulted in a higher risk for a 2nd recurrence (p<0.001). Paper 4 The E-PMR was associated with a lower risk for chronic pain and physical disability compared to AMR, after a previous anterior index repair (OR 0.54 (CI 0.30-0.97), p=0.039). A mean surgeon´s annual volume > 5 O-PMR correlated with a lower risk for chronic pain compared to an surgeon´s annual volume ≤ 5 (OR 0.42 (CI 0.19-0.94), p=0.034). Having a 2nd recurrent repair was associated with a higher risk for chronic pain compared to a 1st recurrent repair (OR 2.89 (CI 1.21-6.88), p=0.017). Conclusions: A posterior mesh repair for recurrent groin hernia surgery was associated with a lower 2nd recurrence rate compared to anterior mesh repair. A posterior mesh repair for the 1st recurrent operation is recommended after an anterior index repair and an anterior mesh repair after a posterior index operation. Endoscopic repairs have the lowest risk for both a 2nd recurrence and chronic groin pain and physical disability. An O-PMR performed trough a Nyhus incision is preferred and the TIPP procedure should be avoided. An surgeon´s annual volume > 5 O-PMR resulted in a lower 2nd recurrence rate and a lower risk for chronic pain. The risk for further recurrence increases with increasing number of groin hernia operations and the risk for chronic pain increases after a 2nd recurrent repair."]},{"key":"dc:format","label":"Dc Format","values":["application/pdf"]},{"key":"dc:source","label":"Dc Source","values":["Lund University Faculty of Medicine Doctoral Dissertation Series; 2014:141 (2014)","ISSN: 1652-8220"]},{"key":"dc:title","label":"Title","values":["Recurrent groin hernia - Outcome after surgery"]}]}],"canonical_facts":{"dc:creator":["Sevonius, Dan"],"dc:date":["2014"],"dc:description":["Background: According to the Swedish Hernia Register (SHR), the reoperation rate after recurrent groin hernia is more than twice that following primary hernia repair. Aims: To study the impact of method of mesh repair used in recurrent groin hernia surgery on re-recurrence as well as chronic pain and physical disability. Methods: Papers 1 and 2 were based on nationwide data from the SHR 1992-2008. In Paper 1 the cumulative risk for reoperation was studied after repeated surgery for recurrent hernia. In Paper 2 the risk for reoperation was analysed in relation to the mesh method used for recurrent hernia repair, taking the previous (index) repair into account. Papers 3 and 4 were based on a cohort of 1st and 2nd recurrent repairs performed at 5 hospitals in the south-west region of Sweden 1998-2007. A follow-up was performed 2009 using the Inguinal Pain Questionnaire (IPQ) and a selective clinical examination. In Paper 3 the risk for a 2nd recurrence was studied in relation to Anterior (AMR) and Posterior Mesh Repairs (PMR) and in Paper 4 the hazard ratio for chronic pain and physical disability was studied in relation to type of mesh repair and mean surgeon´s annual volume. Results: Paper 1 The risk for a further reoperation increased with the number of recurrent repairs (p<0.001). Paper 2 Endoscopic (E-PMR) and open PMR (O-PMR) were associated with the lowest risk for reoperation when the index repair was an anterior repair (p<0.001) Paper 3. PMR was associated with a decreased 2nd recurrence rate compared with AMR (p=0.025). An increased risk for a subsequent 2nd recurrence was seen an after anterior index repair followed by an AMR (HR 3.21 (CI 1.33-7.44), p=0.009)) and a decreased risk after posterior index repair followed by an AMR (HR 0.08 (CI 0.01-0.94), p=0.045). In the O-PMR group there was a lower 2nd recurrence rate after a Nyhus approach (2.5 %) compared to a trans inguinal approach (TIPP) (28 %) (p=0.001). A mean surgeon´s annual volume ≤ 5 O-PMR resulted in a higher risk for a 2nd recurrence (p<0.001). Paper 4 The E-PMR was associated with a lower risk for chronic pain and physical disability compared to AMR, after a previous anterior index repair (OR 0.54 (CI 0.30-0.97), p=0.039). A mean surgeon´s annual volume > 5 O-PMR correlated with a lower risk for chronic pain compared to an surgeon´s annual volume ≤ 5 (OR 0.42 (CI 0.19-0.94), p=0.034). Having a 2nd recurrent repair was associated with a higher risk for chronic pain compared to a 1st recurrent repair (OR 2.89 (CI 1.21-6.88), p=0.017). Conclusions: A posterior mesh repair for recurrent groin hernia surgery was associated with a lower 2nd recurrence rate compared to anterior mesh repair. A posterior mesh repair for the 1st recurrent operation is recommended after an anterior index repair and an anterior mesh repair after a posterior index operation. Endoscopic repairs have the lowest risk for both a 2nd recurrence and chronic groin pain and physical disability. An O-PMR performed trough a Nyhus incision is preferred and the TIPP procedure should be avoided. An surgeon´s annual volume > 5 O-PMR resulted in a lower 2nd recurrence rate and a lower risk for chronic pain. The risk for further recurrence increases with increasing number of groin hernia operations and the risk for chronic pain increases after a 2nd recurrent repair."],"dc:format":["application/pdf"],"dc:identifier":["https://lup.lub.lu.se/record/4778912","urn:isbn:978-91-7619-070-8","https://portal.research.lu.se/files/3914383/4778913.pdf"],"dc:language":["eng"],"dc:publisher":["Surgery, Faculty of Medicine, Lund University"],"dc:rights":["info:eu-repo/semantics/openAccess"],"dc:source":["Lund University Faculty of Medicine Doctoral Dissertation Series; 2014:141 (2014)","ISSN: 1652-8220"],"dc:subject":["Surgery","Groin hernia","inguinal hernia","recurrence","re-recurrence","mesh repair","chronic pain","hernia register"],"dc:title":["Recurrent groin hernia - Outcome after surgery"],"dc:type":["thesis/doccomp","info:eu-repo/semantics/doctoralThesis","text"]},"updated_at":"2026-07-24T02:59:49Z"}