# Recurrence and patient reported outcomes after simultaneous bilateral versus unilateral groin hernia repair: prospective nationwide cohort study

## TL;DR

This study finds that simultaneous bilateral groin hernia repair increases chronic pain and patient dissatisfaction compared to unilateral repair, especially in women and younger patients.

## Contribution

The study provides new evidence on the long-term outcomes of bilateral versus unilateral groin hernia repair using nationwide prospective data.

## Key findings

- Bilateral groin hernia repair is associated with higher chronic pain (16.2% vs 15.4%) and dissatisfaction compared to unilateral repair.
- Women and patients under 50 years old are at higher risk for chronic pain and dissatisfaction after bilateral repair.
- No significant difference in recurrence rates was observed between the two repair types.

## Abstract

Bilateral groin hernias comprise approximately 25% of all groin hernias, with one side often being asymptomatic/minimally symptomatic. With an increase in minimally invasive approaches, simultaneous bilateral groin hernia repair (B-GHR) is frequently performed in routine practice. However, chronic pain and recurrence remain significant postoperative concerns. This study evaluated long-term outcomes after B-GHR versus unilateral groin hernia repairs (U-GHR).

This nationwide population-based cohort study used prospective data from the Swedish Hernia Register, combined with a patient-reported outcome measure (PROM) questionnaire. All men and women aged ≥ 15 years with groin hernia repair registered between 1 September 2012 and 31 December 2018 were included in the study. Primary outcomes were chronic pain and patient dissatisfaction 1 year after B-GHR versus U-GHR. Secondary outcomes included reoperation for recurrence up until 2020, and risk factors for these long-term outcomes exclusively after B-GHR.

In all, 65 749 patients provided PROM data for analysis (response rate 69.4%). Chronic pain at 1 year was reported by 16.2% of patients (27) after B-GHR and by 15.4% of patients (9232) after U-GHR. A higher proportion of women undergoing B-GHR reported increased chronic pain than men (23.0 versus 15.4%; P < 0.001). Multivariable regression analyses revealed a higher risk of chronic pain (odds ratio (OR) 1.14; P = 0.002) and patient dissatisfaction (OR 1.30; P < 0.001) after B-GHR than U-GHR. Female sex and age < 50 years were independent risk factors for chronic pain and patient dissatisfaction after B-GHR. No significant difference was observed in reoperation rates for recurrence.

B-GHR is associated with an increased risk of chronic pain and patient dissatisfaction compared with U-GHR. Women and younger patients are particularly at risk, suggesting a more cautious approach to simultaneous B-GHR in routine practice, especially in the absence of clear symptoms, and highlighting the importance of watchful waiting.

This large-scaled nationwide cohort study including both sexes found a significantly higher associated risk of both chronic pain and patient dissatisfaction 1 year after bilateral compared with unilateral groin hernia repair. Women and younger patients are particularly at risk, suggesting a more cautious approach to simultaneous bilateral groin hernia repair in routine practice, especially in the absence of clear symptoms, and highlighting the importance of watchful waiting.