Abstract：
BACKGROUND: Patients undergoing unilateral inguinal hernia repair (IHR) are at risk of metachronous contralateral inguinal hernia (MCIH) development. We evaluated incidence and risk factors of MCIH development up to 25 years after unilateral IHR to determine possible indications for concomitant prophylactic surgery of the contralateral groin at the time of primary surgery.
METHODS: Patients between 18 and 70 years of age undergoing elective unilateral IHR in the University Hospital of Leuven from 1995 to 1999 were studied retrospectively using the electronic health records and prospectively via phone calls. Study aims were MCIH incidence and risk factor determination. Kaplan-Meier curves were constructed and univariable and multivariable Cox regressions were performed.
RESULTS: 758 patients were included (91% male, median age 53 years). Median follow-up time was 21.75 years. The incidence of operated MCIH after 5 years was 5.6%, after 15 years 16.1%, and after 25 years 24.7%. The incidence of both operated and non-operated MCIH after 5 years was 5.9%, after 15 years 16.7%, and after 25 years 29.0%. MCIH risk increased with older age and decreased in primary right-sided IHR and higher BMI at primary surgery.
CONCLUSIONS: The overall incidence of MCIH after 25-year follow-up is 29.0%. Potential risk factors for the development of a MCIH are primary left-sided inguinal hernia repair, lower BMI, and older age. When considering prophylactic repair, we suggest a patient-specific approach taking into account these risk factors, the surgical approach and the risk factors for chronic postoperative inguinal pain.
METHODS: Patients between 18 and 70 years of age undergoing elective unilateral IHR in the University Hospital of Leuven from 1995 to 1999 were studied retrospectively using the electronic health records and prospectively via phone calls. Study aims were MCIH incidence and risk factor determination. Kaplan-Meier curves were constructed and univariable and multivariable Cox regressions were performed.
RESULTS: 758 patients were included (91% male, median age 53 years). Median follow-up time was 21.75 years. The incidence of operated MCIH after 5 years was 5.6%, after 15 years 16.1%, and after 25 years 24.7%. The incidence of both operated and non-operated MCIH after 5 years was 5.9%, after 15 years 16.7%, and after 25 years 29.0%. MCIH risk increased with older age and decreased in primary right-sided IHR and higher BMI at primary surgery.
CONCLUSIONS: The overall incidence of MCIH after 25-year follow-up is 29.0%. Potential risk factors for the development of a MCIH are primary left-sided inguinal hernia repair, lower BMI, and older age. When considering prophylactic repair, we suggest a patient-specific approach taking into account these risk factors, the surgical approach and the risk factors for chronic postoperative inguinal pain.
摘要：
背景：接受单侧腹股沟疝修补术（IHR）的患者有发生异时对侧腹股沟疝（MCIH）的风险。我们评估了单侧IHR后长达25年的MCIH发展的发生率和危险因素，以确定在初次手术时同时进行对侧腹股沟预防性手术的可能指征。
方法：使用电子健康记录和前瞻性电话对1995年至1999年在鲁汶大学医院接受择期单侧IHR的18至70岁患者进行回顾性研究。研究目的是MCIH发生率和危险因素的确定。建立Kaplan-Meier曲线，进行单变量和多变量Cox回归。
结果：纳入758例患者（91%为男性，中位年龄53岁)。中位随访时间为21.75年。术后5年MCIH的发生率为5.6%,15年后16.1%，25年后为24.7%。5年后手术和非手术的MCIH发生率均为5.9％，15年后的16.7%，25年后29.0%。MCIH风险随着年龄的增长而增加，在原发性右侧IHR和原发性手术时BMI升高而降低。
结论：25年随访后MCIH的总发生率为29.0%。MCIH发展的潜在危险因素是原发性左侧腹股沟疝修补术，较低的BMI,和老年。当考虑预防性修复时，我们建议考虑到这些风险因素，针对患者的方法，慢性术后腹股沟痛的手术方式和危险因素。
方法：使用电子健康记录和前瞻性电话对1995年至1999年在鲁汶大学医院接受择期单侧IHR的18至70岁患者进行回顾性研究。研究目的是MCIH发生率和危险因素的确定。建立Kaplan-Meier曲线，进行单变量和多变量Cox回归。
结果：纳入758例患者（91%为男性，中位年龄53岁)。中位随访时间为21.75年。术后5年MCIH的发生率为5.6%,15年后16.1%，25年后为24.7%。5年后手术和非手术的MCIH发生率均为5.9％，15年后的16.7%，25年后29.0%。MCIH风险随着年龄的增长而增加，在原发性右侧IHR和原发性手术时BMI升高而降低。
结论：25年随访后MCIH的总发生率为29.0%。MCIH发展的潜在危险因素是原发性左侧腹股沟疝修补术，较低的BMI,和老年。当考虑预防性修复时，我们建议考虑到这些风险因素，针对患者的方法，慢性术后腹股沟痛的手术方式和危险因素。
