8/23/2019 Overview of complications of inguinal and femoral hernia repair - UpToDate

Author: David C Brooks, MD

Section Editors: Michael Rosen, MD, Jerome P Richie, MD, FACS
Deputy Editor: Wenliang Chen, MD, PhD

INTRODUCTION

Complications after inguinal or femoral hernia repair are relatively common. The incidence is
higher after emergent repairs and recurrent hernia repairs compared with elective repair. With
the transition to tension-free repair, hernia recurrence is less frequent, while other complications,
such as post-herniorrhaphy neuralgia, have become more prominent.

Complications that occur in the perioperative period include wound seroma/hematoma, urinary
retention, bladder injury, and superficial incisional surgical site infection (SSI), while
complications that occur later following hernia repair include persistent groin pain and post-
herniorrhaphy neuralgia, testicular complications, deep incisional/mesh infection, recurrent
hernia, and mesh migration and erosion.

Complications associated with inguinal and femoral hernia repair will be reviewed here. The
operative techniques for inguinal and femoral hernia repair, including methods to prevent
complications related to repair, are reviewed elsewhere. (See "Open surgical repair of inguinal
and femoral hernia in adults" and "Laparoscopic inguinal and femoral hernia repair in adults".)

INCIDENCE

Complications after inguinal or femoral hernia repair are relatively common, with the incidence
depending upon the clinical circumstance under which the repair was performed as well as the
site and type of the hernia [1].

Urgent and emergent procedures are associated with higher complication rates compared with
elective repair [2,3]. In one review of 1034 groin hernia repairs, overall complication rates were
27 percent for acute hernia repairs and 15.1 percent for elective repairs [3]. Higher complication
rates are also seen with repair of recurrent hernia compared with primary hernia repair. In
studies comparing open and laparoscopic repair, the overall incidence of complications is similar;
however, the nature of the complications differs. Identifiable differences are discussed below.
(See "Overview of treatment for inguinal and femoral hernia in adults", section on 'Primary
hernia'.)

https://www.uptodate.com/contents/overview-of-complications-of-inguinal-and-femoral-hernia-repair 1/5
8/23/2019 Overview of complications of inguinal and femoral hernia repair - UpToDate

To continue reading this article, you must log in with your personal, hospital, or
group practice subscription.

Subscribe Log In

Literature review current through: Jul 2019. | This topic last updated: May 15, 2018.

The content on the UpToDate website is not intended nor recommended as a substitute for
medical advice, diagnosis, or treatment. Always seek the advice of your own physician or
other qualified health care professional regarding any medical questions or conditions. The
use of UpToDate content is governed by the UpToDate Terms of Use. ©2019 UpToDate, Inc.
All rights reserved.

REFERENCES

1. Matthews RD, Anthony T, Kim LT, et al. Factors associated with postoperative
complications and hernia recurrence for patients undergoing inguinal hernia repair: a report
from the VA Cooperative Hernia Study Group. Am J Surg 2007; 194:611.

2. Koch A, Edwards A, Haapaniemi S, et al. Prospective evaluation of 6895 groin hernia

repairs in women. Br J Surg 2005; 92:1553.

3. Abi-Haidar Y, Sanchez V, Itani KM. Risk factors and outcomes of acute versus elective
groin hernia surgery. J Am Coll Surg 2011; 213:363.

4. Fitzgibbons RJ Jr, Giobbie-Hurder A, Gibbs JO, et al. Watchful waiting vs repair of inguinal
hernia in minimally symptomatic men: a randomized clinical trial. JAMA 2006; 295:285.

5. Hawn MT, Itani KM, Giobbie-Hurder A, et al. Patient-reported outcomes after inguinal
herniorrhaphy. Surgery 2006; 140:198.

6. Falagas ME, Kasiakou SK. Mesh-related infections after hernia repair surgery. Clin
Microbiol Infect 2005; 11:3.

7. Kocot A, Gerharz EW, Riedmiller H. Urological complications of laparoscopic inguinal

hernia repair: a case series. Hernia 2011; 15:583.

8. Gulino G, Antonucci M, Palermo G, et al. Urological complications following inguinal

hernioplasty. Arch Ital Urol Androl 2012; 84:105.

https://www.uptodate.com/contents/overview-of-complications-of-inguinal-and-femoral-hernia-repair 2/5
8/23/2019 Overview of complications of inguinal and femoral hernia repair - UpToDate

9. Köckerling F, Jacob DA, Bittner R, et al. Risk of postoperative urinary retention after
laparoscopic (TAPP) or endoscopic (TEP) inguinal hernia repair. Surg Endosc 2013;
27:1049.

10. Bittner R, Schmedt CG, Schwarz J, et al. Laparoscopic transperitoneal procedure for
routine repair of groin hernia. Br J Surg 2002; 89:1062.

11. Winslow ER, Quasebarth M, Brunt LM. Perioperative outcomes and complications of open
vs laparoscopic extraperitoneal inguinal hernia repair in a mature surgical practice. Surg
Endosc 2004; 18:221.

12. Inaba T, Okinaga K, Fukushima R, et al. Chronic pain and discomfort after inguinal hernia
repair. Surg Today 2012; 42:825.

13. Schmedt CG, Sauerland S, Bittner R. Comparison of endoscopic procedures vs

Lichtenstein and other open mesh techniques for inguinal hernia repair: a meta-analysis of
randomized controlled trials. Surg Endosc 2005; 19:188.

14. Schwab JR, Beaird DA, Ramshaw BJ, et al. After 10 years and 1903 inguinal hernias, what
is the outcome for the laparoscopic repair? Surg Endosc 2002; 16:1201.

15. Berney CR. Risk of postoperative urinary retention after laparoscopic (TAPP) or
endoscopic (TEP) inguinal hernia repair. Surg Endosc 2013; 27:694.

16. Kaul A, Hutfless S, Le H, et al. Staple versus fibrin glue fixation in laparoscopic total
extraperitoneal repair of inguinal hernia: a systematic review and meta-analysis. Surg
Endosc 2012; 26:1269.

17. Tam KW, Liang HH, Chai CY. Outcomes of staple fixation of mesh versus nonfixation in
laparoscopic total extraperitoneal inguinal repair: a meta-analysis of randomized controlled
trials. World J Surg 2010; 34:3065.

18. Garg P, Rajagopal M, Varghese V, Ismail M. Laparoscopic total extraperitoneal inguinal

hernia repair with nonfixation of the mesh for 1,692 hernias. Surg Endosc 2009; 23:1241.

19. Garg P, Nair S, Shereef M, et al. Mesh fixation compared to nonfixation in total
extraperitoneal inguinal hernia repair: a randomized controlled trial in a rural center in
India. Surg Endosc 2011; 25:3300.

20. Bittner R, Arregui ME, Bisgaard T, et al. Guidelines for laparoscopic (TAPP) and
endoscopic (TEP) treatment of inguinal hernia [International Endohernia Society (IEHS)].
Surg Endosc 2011; 25:2773.

https://www.uptodate.com/contents/overview-of-complications-of-inguinal-and-femoral-hernia-repair 3/5
8/23/2019 Overview of complications of inguinal and femoral hernia repair - UpToDate

21. Doehn C, Fornara P, Miglietti G, Jocham D. Uraemia after laparoscopic bilateral hernia
repair. Nephrol Dial Transplant 1998; 13:1265.

22. Sanchez-Manuel FJ, Seco-Gil JL. Antibiotic prophylaxis for hernia repair. Cochrane
Database Syst Rev 2003; :CD003769.

23. Sanabria A, Domínguez LC, Valdivieso E, Gómez G. Prophylactic antibiotics for mesh
inguinal hernioplasty: A meta-analysis. Ann Surg 2007; 245:392.

24. Gilbert AI, Felton LL. Infection in inguinal hernia repair considering biomaterials and
antibiotics. Surg Gynecol Obstet 1993; 177:126.

25. Nilsson H, Angerås U, Sandblom G, Nordin P. Serious adverse events within 30 days of
groin hernia surgery. Hernia 2016; 20:377.

26. Alfieri S, Amid PK, Campanelli G, et al. International guidelines for prevention and
management of post-operative chronic pain following inguinal hernia surgery. Hernia 2011;
15:239.

27. Eklund A, Rudberg C, Smedberg S, et al. Short-term results of a randomized clinical trial
comparing Lichtenstein open repair with totally extraperitoneal laparoscopic inguinal hernia
repair. Br J Surg 2006; 93:1060.

28. Grant AM, Scott NW, O'Dwyer PJ, MRC Laparoscopic Groin Hernia Trial Group. Five-year
follow-up of a randomized trial to assess pain and numbness after laparoscopic or open
repair of groin hernia. Br J Surg 2004; 91:1570.

29. Shin D, Lipshultz LI, Goldstein M, et al. Herniorrhaphy with polypropylene mesh causing
inguinal vasal obstruction: a preventable cause of obstructive azoospermia. Ann Surg
2005; 241:553.

30. Delikoukos S, Tzovaras G, Liakou P, et al. Late-onset deep mesh infection after inguinal
hernia repair. Hernia 2007; 11:15.

31. Moon V, Chaudry GA, Choy C, Ferzli GS. Mesh infection in the era of laparoscopy. J
Laparoendosc Adv Surg Tech A 2004; 14:349.

32. Neumayer L, Giobbie-Hurder A, Jonasson O, et al. Open mesh versus laparoscopic mesh
repair of inguinal hernia. N Engl J Med 2004; 350:1819.

33. Costerton JW, Stewart PS, Greenberg EP. Bacterial biofilms: a common cause of
persistent infections. Science 1999; 284:1318.

34. Donlan RM. Biofilm formation: a clinically relevant microbiological process. Clin Infect Dis
2001; 33:1387.
https://www.uptodate.com/contents/overview-of-complications-of-inguinal-and-femoral-hernia-repair 4/5
8/23/2019 Overview of complications of inguinal and femoral hernia repair - UpToDate

35. Vuong C, Gerke C, Somerville GA, et al. Quorum-sensing control of biofilm factors in
Staphylococcus epidermidis. J Infect Dis 2003; 188:706.

36. Taylor SG, O'Dwyer PJ. Chronic groin sepsis following tension-free inguinal hernioplasty.
Br J Surg 1999; 86:562.

37. Nolla-Salas J, Torres-Rodríguez JM, Grau S, et al. Successful treatment with liposomal
amphotericin B of an intraabdomianl abscess due to Candida norvegensis associated with
a Gore-Tex mesh infection. Scand J Infect Dis 2000; 32:560.

38. Matthews MR, Caruso DM, Tsujimura RB, et al. Ventral hernia synthetic mesh repair
infected by Mycobacterium fortuitum. Am Surg 1999; 65:1035.

39. Deysine M. Pathophysiology, prevention, and management of prosthetic infections in

hernia surgery. Surg Clin North Am 1998; 78:1105.

40. Kuo YC, Mondschein JI, Soulen MC, et al. Drainage of collections associated with hernia
mesh: is it worthwhile? J Vasc Interv Radiol 2010; 21:362.

41. Cingi A, Manukyan MN, Güllüoğlu BM, et al. Use of resterilized polypropylene mesh in
inguinal hernia repair: a prospective, randomized study. J Am Coll Surg 2005; 201:834.

42. Terzi C, Kiliç D, Unek T, et al. Single-dose oral ciprofloxacin compared with single-dose
intravenous cefazolin for prophylaxis in inguinal hernia repair: a controlled randomized
clinical study. J Hosp Infect 2005; 60:340.

43. Rehman S, Khan S, Pervaiz A, Perry EP. Recurrence of inguinal herniae following removal
of infected prosthetic meshes: a review of the literature. Hernia 2012; 16:123.

44. Salvati EA, Chekofsky KM, Brause BD, Wilson PD Jr. Reimplantation in infection: a 12-
year experience. Clin Orthop Relat Res 1982; :62.

45. Agrawal A, Avill R. Mesh migration following repair of inguinal hernia: a case report and
review of literature. Hernia 2006; 10:79.

https://www.uptodate.com/contents/overview-of-complications-of-inguinal-and-femoral-hernia-repair 5/5