Long-term outcomes after elective inguinal hernia mesh-repair in patients with inflammatory bowel disease

Hans Lovén; Rune Erichsen; Anders Tøttrup; Thue Bisgaard

doi:10.1007/s10029-025-03362-3

Long-term outcomes after elective inguinal hernia mesh-repair in patients with inflammatory bowel disease

Hans Lovén^*
, Rune Erichsen
, Anders Tøttrup
, Thue Bisgaard

^*Corresponding author for this work

Center for Surgical Science

Research output: Contribution to journal › Article › Research › peer-review

Abstract

BACKGROUND: Knowledge of long-term outcomes following elective inguinal hernia mesh-repair in patients with inflammatory bowel disease (IBD) remains limited. Pathophysiological differences between Crohn's disease (CD) and ulcerative colitis (UC) may influence mesh-related complications and recurrence risk. The primary objective was to assess the reoperation risk for mesh-related complications, and secondarily, recurrence after inguinal hernia mesh-repair in patients with CD and UC. The impact of fistulising disease (intra-abdominal/perianal) and surgical technique (open/laparoscopic) on both outcomes was also analysed based on the available data.

METHODS: This nationwide cohort study (2007-2016) followed IBD patients undergoing elective inguinal hernia mesh-repair to assess risks of reoperation for mesh-related complications or recurrence. Risks were estimated using cumulative incidence and Cox regression analyses.

RESULTS: Among 1,072 patients with IBD (CD = 264, UC = 698, IBD-unclassified = 110), the five-year reoperation risk was 0.5% for mesh-related complications and 5.7% for recurrence. Fistulising disease was present in 6.9% (n = 74) of all patients with IBD: perianal in 95% (n = 70) and intra-abdominal in 5% (n = 4). There were too few mesh-related complications (n = 5) to support statistical analysis of this outcome. Recurrence risk was not significantly affected by IBD subtype: CD (reference), UC (HR = 1.67, 95% CI: 0.77-3.64), IBD-U (HR = 0.91, 95% CI: 0.24-3.44), or surgical technique: transabdominal preperitoneal (TAPP) (reference), and Lichtenstein (HR = 0.80, 95% CI: 0.43-1.47).

CONCLUSION: This study suggests that inguinal hernia mesh-repair is also safe among IBD patients regardless of subtype, surgical technique, or perianal fistulation. Similarly, recurrence risk was unaffected by these factors. Limited data prevented conclusions on intra-abdominal fistulising disease as a potential risk-factor for poor surgical outcomes.

Original language	English
Article number	183
Number of pages	8
Journal	Hernia : the journal of hernias and abdominal wall surgery
Volume	29
Issue number	1
DOIs	https://doi.org/10.1007/s10029-025-03362-3
Publication status	Published - 23 May 2025

Funding

Funders
Region Sjælland

Keywords

Humans
Hernia, Inguinal/surgery
Surgical Mesh/adverse effects
Male
Female
Recurrence
Adult
Herniorrhaphy/adverse effects
Middle Aged
Elective Surgical Procedures
Reoperation/statistics & numerical data
Postoperative Complications/epidemiology
Crohn Disease/complications
Treatment Outcome
Aged
Colitis, Ulcerative/complications
Inflammatory Bowel Diseases/complications
Ibd
Lichtenstein
Crohn's disease
Tapp
Meshrelated complications
Inguinal hernia repair
Fistulising disease
Ulcerative colitis

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10.1007/s10029-025-03362-3Licence: CC BY

Cite this

@article{0e0ffce38c0840e3800874254f76547c,

title = "Long-term outcomes after elective inguinal hernia mesh-repair in patients with inflammatory bowel disease",

abstract = "BACKGROUND: Knowledge of long-term outcomes following elective inguinal hernia mesh-repair in patients with inflammatory bowel disease (IBD) remains limited. Pathophysiological differences between Crohn's disease (CD) and ulcerative colitis (UC) may influence mesh-related complications and recurrence risk. The primary objective was to assess the reoperation risk for mesh-related complications, and secondarily, recurrence after inguinal hernia mesh-repair in patients with CD and UC. The impact of fistulising disease (intra-abdominal/perianal) and surgical technique (open/laparoscopic) on both outcomes was also analysed based on the available data.METHODS: This nationwide cohort study (2007-2016) followed IBD patients undergoing elective inguinal hernia mesh-repair to assess risks of reoperation for mesh-related complications or recurrence. Risks were estimated using cumulative incidence and Cox regression analyses.RESULTS: Among 1,072 patients with IBD (CD = 264, UC = 698, IBD-unclassified = 110), the five-year reoperation risk was 0.5\% for mesh-related complications and 5.7\% for recurrence. Fistulising disease was present in 6.9\% (n = 74) of all patients with IBD: perianal in 95\% (n = 70) and intra-abdominal in 5\% (n = 4). There were too few mesh-related complications (n = 5) to support statistical analysis of this outcome. Recurrence risk was not significantly affected by IBD subtype: CD (reference), UC (HR = 1.67, 95\% CI: 0.77-3.64), IBD-U (HR = 0.91, 95\% CI: 0.24-3.44), or surgical technique: transabdominal preperitoneal (TAPP) (reference), and Lichtenstein (HR = 0.80, 95\% CI: 0.43-1.47).CONCLUSION: This study suggests that inguinal hernia mesh-repair is also safe among IBD patients regardless of subtype, surgical technique, or perianal fistulation. Similarly, recurrence risk was unaffected by these factors. Limited data prevented conclusions on intra-abdominal fistulising disease as a potential risk-factor for poor surgical outcomes.",

keywords = "Humans, Hernia, Inguinal/surgery, Surgical Mesh/adverse effects, Male, Female, Recurrence, Adult, Herniorrhaphy/adverse effects, Middle Aged, Elective Surgical Procedures, Reoperation/statistics \& numerical data, Postoperative Complications/epidemiology, Crohn Disease/complications, Treatment Outcome, Aged, Colitis, Ulcerative/complications, Inflammatory Bowel Diseases/complications, Ibd, Lichtenstein, Crohn's disease, Tapp, Meshrelated complications, Inguinal hernia repair, Fistulising disease, Ulcerative colitis",

author = "Hans Lov{\'e}n and Rune Erichsen and Anders T{\o}ttrup and Thue Bisgaard",

note = "{\textcopyright} 2025. The Author(s).",

year = "2025",

month = may,

day = "23",

doi = "10.1007/s10029-025-03362-3",

language = "English",

volume = "29",

journal = "Hernia : the journal of hernias and abdominal wall surgery",

issn = "1265-4906",

publisher = "Springer-Verlag Italia",

number = "1",

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TY - JOUR

T1 - Long-term outcomes after elective inguinal hernia mesh-repair in patients with inflammatory bowel disease

AU - Lovén, Hans

AU - Erichsen, Rune

AU - Tøttrup, Anders

AU - Bisgaard, Thue

PY - 2025/5/23

Y1 - 2025/5/23

N2 - BACKGROUND: Knowledge of long-term outcomes following elective inguinal hernia mesh-repair in patients with inflammatory bowel disease (IBD) remains limited. Pathophysiological differences between Crohn's disease (CD) and ulcerative colitis (UC) may influence mesh-related complications and recurrence risk. The primary objective was to assess the reoperation risk for mesh-related complications, and secondarily, recurrence after inguinal hernia mesh-repair in patients with CD and UC. The impact of fistulising disease (intra-abdominal/perianal) and surgical technique (open/laparoscopic) on both outcomes was also analysed based on the available data.METHODS: This nationwide cohort study (2007-2016) followed IBD patients undergoing elective inguinal hernia mesh-repair to assess risks of reoperation for mesh-related complications or recurrence. Risks were estimated using cumulative incidence and Cox regression analyses.RESULTS: Among 1,072 patients with IBD (CD = 264, UC = 698, IBD-unclassified = 110), the five-year reoperation risk was 0.5% for mesh-related complications and 5.7% for recurrence. Fistulising disease was present in 6.9% (n = 74) of all patients with IBD: perianal in 95% (n = 70) and intra-abdominal in 5% (n = 4). There were too few mesh-related complications (n = 5) to support statistical analysis of this outcome. Recurrence risk was not significantly affected by IBD subtype: CD (reference), UC (HR = 1.67, 95% CI: 0.77-3.64), IBD-U (HR = 0.91, 95% CI: 0.24-3.44), or surgical technique: transabdominal preperitoneal (TAPP) (reference), and Lichtenstein (HR = 0.80, 95% CI: 0.43-1.47).CONCLUSION: This study suggests that inguinal hernia mesh-repair is also safe among IBD patients regardless of subtype, surgical technique, or perianal fistulation. Similarly, recurrence risk was unaffected by these factors. Limited data prevented conclusions on intra-abdominal fistulising disease as a potential risk-factor for poor surgical outcomes.

AB - BACKGROUND: Knowledge of long-term outcomes following elective inguinal hernia mesh-repair in patients with inflammatory bowel disease (IBD) remains limited. Pathophysiological differences between Crohn's disease (CD) and ulcerative colitis (UC) may influence mesh-related complications and recurrence risk. The primary objective was to assess the reoperation risk for mesh-related complications, and secondarily, recurrence after inguinal hernia mesh-repair in patients with CD and UC. The impact of fistulising disease (intra-abdominal/perianal) and surgical technique (open/laparoscopic) on both outcomes was also analysed based on the available data.METHODS: This nationwide cohort study (2007-2016) followed IBD patients undergoing elective inguinal hernia mesh-repair to assess risks of reoperation for mesh-related complications or recurrence. Risks were estimated using cumulative incidence and Cox regression analyses.RESULTS: Among 1,072 patients with IBD (CD = 264, UC = 698, IBD-unclassified = 110), the five-year reoperation risk was 0.5% for mesh-related complications and 5.7% for recurrence. Fistulising disease was present in 6.9% (n = 74) of all patients with IBD: perianal in 95% (n = 70) and intra-abdominal in 5% (n = 4). There were too few mesh-related complications (n = 5) to support statistical analysis of this outcome. Recurrence risk was not significantly affected by IBD subtype: CD (reference), UC (HR = 1.67, 95% CI: 0.77-3.64), IBD-U (HR = 0.91, 95% CI: 0.24-3.44), or surgical technique: transabdominal preperitoneal (TAPP) (reference), and Lichtenstein (HR = 0.80, 95% CI: 0.43-1.47).CONCLUSION: This study suggests that inguinal hernia mesh-repair is also safe among IBD patients regardless of subtype, surgical technique, or perianal fistulation. Similarly, recurrence risk was unaffected by these factors. Limited data prevented conclusions on intra-abdominal fistulising disease as a potential risk-factor for poor surgical outcomes.

KW - Humans

KW - Hernia, Inguinal/surgery

KW - Surgical Mesh/adverse effects

KW - Male

KW - Female

KW - Recurrence

KW - Adult

KW - Herniorrhaphy/adverse effects

KW - Middle Aged

KW - Elective Surgical Procedures

KW - Reoperation/statistics & numerical data

KW - Postoperative Complications/epidemiology

KW - Crohn Disease/complications

KW - Treatment Outcome

KW - Aged

KW - Colitis, Ulcerative/complications

KW - Inflammatory Bowel Diseases/complications

KW - Ibd

KW - Lichtenstein

KW - Crohn's disease

KW - Tapp

KW - Meshrelated complications

KW - Inguinal hernia repair

KW - Fistulising disease

KW - Ulcerative colitis

U2 - 10.1007/s10029-025-03362-3

DO - 10.1007/s10029-025-03362-3

M3 - Article

C2 - 40407929

SN - 1265-4906

VL - 29

JO - Hernia : the journal of hernias and abdominal wall surgery

JF - Hernia : the journal of hernias and abdominal wall surgery

IS - 1

M1 - 183

ER -

Long-term outcomes after elective inguinal hernia mesh-repair in patients with inflammatory bowel disease

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