The Importance of Evidence-Based Surgery – The Case of Female Groin Hernia

Abstract Background In 2005 the first study regarding outcome after groin hernia repair in women, based on data from the Swedish Hernia Register (SHR), was published. Women had a substantially higher risk of reoperation due to recurrence than men, and poorer results after open anterior mesh repair. Recommendations and guidelines were issued. The aim of this study was to investigate how implementation of guidelines regarding treatment of groin hernia in females have affected the outcomes. Material and Methods Epidemiological study on prospective data in the SHR. The studied outcome was reoperation due to recurrence, by Cox proportional hazards regression analyses. Results A total of 35,179 groin hernia repairs in women have been registered. The proportion of endo-laparoscopic repairs have increased from 4.9% in 2005 to 84.2% in 2023. The 5-year rate of reoperation due to recurrence for procedures before 2012 was 4.2%, with a hazard ratio of 1.25 (95%CI 1.16–1.35) compared to males. For groin hernia repairs in women 2012–2022 the 5-year reoperation rate was 2.1% with a hazard ratio of 0.67 (95% CI 0.58–0.76) compared to men. There was a significantly reduced risk for women who had endo-laparoscopic repair (HR 0.30, 95% CI 0.23-0.40). Conclusions Following implementation of the evidence-based guidelines for treatment of groin hernia in women the results in terms of reoperation for recurrence have improved significantly.