- Design
- Retrospective registry cohort with inverse probability weighting
- Population
- 4,209 adults with elective unilateral minimally invasive direct inguinal hernia repair
- Primary outcome
- 30-day surgical site occurrence
- Effect
- 3.6% vs 6.2% with vs without closure (p=0.034); cardiac readmissions 2.2% vs 0.3% (3 vs 1 events)
A registry cohort of 4,209 patients having elective unilateral laparoscopic or robotic repair of a direct inguinal hernia compared defect closure with no closure, adjusted using inverse probability weighting.
Closure was associated with fewer 30-day surgical site occurrences (3.6% vs 6.2%, p=0.034) but more cardiac readmissions (2.2% vs 0.3%, p<0.001), which came down to 3 against 1 events. In the robotic subgroup (2,171 patients) the wound benefit was no longer significant (3.9% vs 5.1%, p=0.330).
The cardiac signal rests on a handful of events that the authors judge likely unrelated to closure, and the study is retrospective with practice differences between groups, including mesh fixation and TAP blocks. The authors support selective closure, such as for larger medial defects or higher wound risk. That is a reasonable reading, not a randomised result.
- Consider closing the defect in larger medial defects or patients at higher wound risk.
- Closure was linked to fewer wound events overall, but not significantly so in the robotic subgroup.
- The cardiac readmission difference came from 3 against 1 events; do not act on it.
- Record whether the defect was closed so outcomes can be audited locally.
Why it matters
It turns a long-running either-or question into a case-by-case decision, and flags a signal that needs confirming rather than acting on.
Don't overread it
A retrospective registry cohort; the cardiac finding rests on very few events and is not shown to be caused by closure.
The statistics, in plain English
A small p-value for cardiac readmissions (p<0.001) sounds firm but came from only 4 events in total, so the estimate is unstable. Weighting adjusts for measured characteristics, not for how surgeons chose to close.
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