Clinical outcomes of open versus laparoscopic inguinal hernia mesh repair in Palestine: a multicenter retrospective cohort study

Clinical outcomes of open versus laparoscopic inguinal hernia mesh repair in Palestine: a multicenter retrospective cohort study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical outcomes of open versus laparoscopic inguinal hernia mesh repair in Palestine: a multicenter retrospective cohort study Iyad M. Ballas, Husam N. Abualwafa, Ibrahim H. AL-Shaer, Ibrahim Aljamal, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9087670/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background: Inguinal hernia repair is one of the most frequently performed surgical procedures worldwide, accounting for approximately 75% of abdominal wall hernias, and predominantly occurring in males. Although it is a common procedure with generally favourable outcomes, the postoperative outcomes, such as chronic pain, recurrence, and surgical complications, remain important concerns. Due to the large number of procedures performed worldwide and the associated healthcare costs, the assessment of surgical outcomes and the factors that affect patients’ recovery are essential to optimize management strategies and improve long-term results. The aim of this study was to evaluate postoperative outcomes after inguinal hernia repair in terms of the incidence of complications and postoperative course in an attempt to determine which approach is associated with fewer complications Method: A retrospective cohort study was conducted to compare the outcomes between open vs laparoscopic inguinal hernia mesh repair. All patients who underwent inguinal hernia mesh repair in 3 hospitals from 2017 to 2025 were collected. Patients were divided into groups based on surgical technique (open repair vs laparoscopic repair). Demographic data, operative time, length of hospital stay, postoperative complications including hematoma, seroma, wound infection, hydrocele, urinary retention, vomiting, and recurrence, were extracted and analysed. Statistical analysis was performed by using SPSS to compare outcomes between the two groups, with a P- value <0.05 considered statistically significant. Results: A total of 609 patients underwent inguinal hernia repair with mesh. Open repair was more prevalent (77.2%), while laparoscopic repair represented 22.8% of cases. Laparoscopic repair was more frequently performed for direct hernias, whereas indirect hernias were more commonly treated with open repair (p = 0.037). Reducible and uncomplicated hernias were significantly associated with laparoscopic repair (p < 0.001, p = 0.006), while irreducible and strangulated hernias were predominantly managed with open surgery. Patients undergoing laparoscopic repair were younger (median 51.5 vs. 55 years, p = 0.001) and had shorter operative duration (median 101.5 vs. 113 minutes, p = 0.001). Urinary retention occurred more frequently after open repair (5.5% vs. 0.7%, p = 0.015), whereas postoperative nausea and vomiting were more common following laparoscopy (2.2% vs. 0.2%, p = 0.039). Overall postoperative complications were low and comparable between the two approaches (12.6% vs. 14.4%, p = 0.572), and recurrence rates were minimal with no significant difference between groups (1.1% vs. 1.4%, p = 0.709). Conclusion: Both open and laparoscopic inguinal hernia repair demonstrated favourable safety profiles in this cohort; however, postoperative complications, such as chronic pain, remain a problem for some patients. Careful patient selection, proper surgical technique, and early recognition of risk factors may help improve postoperative outcomes. Further research is needed to improve surgical techniques and reduce postoperative morbidity. Inguinal hernia Hernia repair Laparoscopic surgery Open surgery Mesh repair Retrospective cohort Palestine Background An inguinal hernia is the protrusion of abdominal content through a defect in the abdominal wall into the inguinal canal 1 . An indirect hernia occurs when abdominal contents protrude through the internal ring 2 and follow the inguinal canal, and a direct hernia occurs when the abdominal content pushes directly through a weakened area of the posterior wall of the inguinal canal 3 . Globally, 20 million inguinal hernia operations are performed annually, making it the most frequently repaired by surgical approach 4 , 5 . It is approximately 75% from all abdominal wall hernias and occurs more frequently in males (27%) than in females (3%) 6 . The large number of hernia repair procedures significantly contributes to healthcare resource utilization and economic costs, and exceeds 3 billion euros annually in both low- and high-income settings 7 , 8 . Although inguinal hernia repair is regarded as a routine surgical procedure, there is ongoing debate about the most effective surgical approach (open, laparoscopic, robotic), taking into account outcomes, cost, and patient-specific factors 3 . Literature Review Inguinal hernia repair is one of the most commonly performed surgical procedures worldwide. Over the past decade, open mesh repair (classically the Lichtenstein technique) and laparoscopic mesh repair (TAPP and TEP) have been the dominant operative strategies. Recent evidence and guideline updates from the European Hernia Society and the HerniaSurge Group provide current comparative insights into outcomes and technique selection 1 . The Lichtenstein tension-free mesh repair remains the most widely used open technique. Although originally described several decades ago, it continues to be supported as a standard approach in more recent guideline updates due to its simplicity, reproducibility, and effectiveness for primary unilateral hernias. Open repair typically involves a single groin incision and placement of a mesh over the hernia defect. It remains especially relevant in settings with limited laparoscopic resources or in patients unsuitable for laparoscopy 1 , 9 . Minimally invasive approaches have increasingly been used over the last decade. The two main laparoscopic techniques are Transabdominal Preperitoneal Repair (TAPP), which involves entry into the peritoneal cavity, with dissection of the preperitoneal space. Totally Extraperitoneal Repair (TEP), which is done without entering the peritoneal cavity, minimizing intraperitoneal manipulation. Both TAPP and TEP place mesh in the preperitoneal space via small incisions. Recent comparative studies and meta-analyses demonstrate that laparoscopic approaches are associated with several perioperative benefits compared with open repair 9 . Based on the studies, there were different advantages of the laparoscopic approach as patients have Less postoperative pain. Multiple randomized and observational studies report significantly reduced early postoperative pain scores in patients undergoing TAPP/TEP versus open repair. Furthermore, it was associated with Faster functional recovery. Patients tend to return to daily activities and work sooner. Its advantage is also apparent in repairing bilateral hernia. Both sides can be accessed with the same laparoscopic ports, avoiding bilateral incisions 1 , 9 . Despite these advantages of the laparoscopic approach, open techniques still have multiple advantages and remain a simpler technique. Open repair is technically less complex and does not require specialized laparoscopic skills. And based on the cost, it has a lower cost. Open repair generally incurs lower direct costs due to the absence of laparoscopic equipment. And it is more suitable for complicated cases, e.g. large scrotal or strangulated hernias may be safer via open repair 1 , 10 . Current evidence-based guidelines reinforce that both open and laparoscopic approaches provide effective hernia repair when performed by experienced surgeons. The European Hernia Society and HerniaSurge Group recommend that Laparoscopic approaches (TAPP/TEP) be used for bilateral and recurrent hernias due to advantages in recovery and pain outcomes. While open mesh repair (Lichtenstein) is a reliable option for primary unilateral hernias, especially where laparoscopic expertise is limited or contraindicated 1 , 11 . So, the choice of technique is often influenced by patient factors and surgeon preference. Despite several studies comparing open inguinal hernia repair with mesh vs laparoscopic inguinal hernia repair with mesh, A major gap and controversy still exist in the literature. Evidence regarding several outcomes is still conflicting, causing it to be difficult to show final conclusions. First, operative time appears to be variably reported across studies. Studies show that laparoscopic surgery takes longer due to the difficult and complex placement of the trocar. A recent systematic review found that laparoscopic procedures had significantly longer operative durations compared with open repair 12 . Likewise, complication rates are variably reported. Some evidence indicates that laparoscopic repair may lower the risk of certain wound complications and postoperative pain, it may lead to intra-abdominal and visceral injury that was not reported in the open technique 12 , 13 . Postoperative urinary retention, another commonly assessed outcome for hernia surgery, has shown no consistent difference between laparoscopic and open mesh repair in meta-analytic studies 14 . Possibly most debatable are recurrence rates. Several studies indicate that recurrence rates between laparoscopic and open mesh repairs are equivalent, especially when procedures are performed by expert surgeons; Even so, other older trials demonstrated higher recurrence with laparoscopic repairs in less expert hands 12 , 13 . Furthermore, major evidence arises from studies performed in Europe, the United States, and East Asia with restricted data from the Middle East and limited outcomes in specific region as in Palestine populations. This geographic discrimination emphasizes a distinct gap in knowledge, which restricts the generalizability of findings to local surgical practice and patient populations. Problem statement Expanding on these discrepancies, the regional context further underlines an important evidence gap. Differences in sociodemographic events, such as higher smoking rates in our cohort, could be affect postoperative complications and recurrence. Additionally, differences in hospital facilities (private versus governmental hospitals), resource availability, and surgeon experience may significantly affect the surgical endpoint. Until now, no large Palestinian cohort has directly compared open and laparoscopic mesh repair outcomes. Therefore, local evidence is essential to direct surgical judgment and healthcare policy in the region. The study aims to provide real – world data from a large Palestinian cohort. Study objectives Primary objective: To compare open and laparoscopic inguinal hernia repair in terms of postoperative outcomes. ¬ Secondary objectives: To find descriptive data in patients with inguinal hernia in Palestine. To assess the association between the type of surgery and postoperative complications. To assess the association between the type of surgery and intraoperative complications. To assess the association between the type of surgery and socio-demographic data. Methods Study design This study was designed as a retrospective cohort study evaluating outcomes of open and laparoscopic inguinal hernia repair in three hospitals in the West Bank between January 2017 and December 2025. This study was conducted and reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Study setting This study included three hospitals in the West Bank ( Ibn Sina Specialized Hospital, Jenin Governmental Hospital, and Makassed Islamic Charitable Hospital), two of which are private hospitals and one governmental hospital. The hospitals are located in the northern and central regions of the West Bank, ensuring representation from different healthcare sectors and geographic areas. Study population We included patients who met the inclusion criteria and were operated on with inguinal hernia repair with mesh, either open or laparoscopic surgery, from 2017 to 2025. Inclusion criteria: Adult patients (> 18 years) Diagnosed with a primary unilateral or bilateral inguinal hernia Underwent open or laparoscopic mesh repair Complete medical records, including operative notes and follow-up data were required Exclusion criteria: Patient under 18 years old Non- mesh repairs of inguinal hernias Recurrent inguinal hernia without documented data Femoral hernia Missing operative data Any laparoscopic hernia repair converted to open repair Sample size This was a retrospective comparative cohort study. All adult patients who underwent inguinal hernia repair with mesh (laparoscopic or open) at [Ibn Sina specialized hospital, Jenin governmental hospital, and Makassed Islamic charitable hospital] between [1/1/2017] and [25/12/2025] were included. No a priori sample size calculation was performed because the study used total population sampling of all eligible cases during the study period. Data collection A data collection sheet was created to include all variables related to our research (socio-demographic, clinical, preoperative, and outcomes). These data were extracted from medical records, operative reports, and clinic follow-up notes, and kept saved without name or hospital id in password protected file only accessed by the authors. Statistical analysis Statistical analysis was carried out using SPSS version 27. Descriptive statistics were employed to describe sociodemographic factors and perioperative data. Categorical variables were described using frequency and percentage. Continuous variables were described using median and interquartile range (IQR) since the data were not normally distributed, as evidenced by the Shapiro-Wilk test. The Chi-square test was employed to evaluate associations between categorical variables and the type of surgery. The Fisher’s exact test was used when the expected cell count was less than 5. The Mann-Whitney U test was employed to compare groups for continuous variables that were not normally distributed. A p-value of less than 0.05 was considered statistically significant for all tests. Denominators differed for variables due to missing data. Ethical Approval The study was conducted after ethical approval from the IRB at Arab American University, before data collection. Patient data were collected from their medical records. Each patient was given a special code, and stored without patient identifiers in password protected file, only accessed by the authors. Result Descriptive analysis Categorical variables were presented with frequencies and percentages (table1), and continuous variables were summarized by median and interquartile ranges (IQRs) due to non-normal distribution (Table 2) Sociodemographic characteristics A total of 609 patients were included in the study. The median age was 64.5 years (interquartile range [IQR]: 51.25–74.0), with ages ranging from 18 to 80 years. The majority of participants were male (95.4%) and married (91.6%). Regarding smoking status, 73.4% of participants were smokers. Overall, 42.2% of patients had at least one comorbidity. Hypertension was present in 24.0%, diabetes mellitus in 15.1%, and ischemic heart disease in 7.7%. In terms of occupational and lifestyle factors, 12.5% reported heavy lifting. A history of previous surgical procedures was noted in 53.5% of participants, and 21.2% had undergone prior groin surgery. All participants were diagnosed with an inguinal hernia and underwent surgical repair on either an elective or emergency basis. Clinical Presentation Prior to Surgery The median duration of symptoms was 12 months (IQR: 2–36 months). The median preoperative pain score was low, with a median pain score of 1.0 out of 10 (IQR: 0–2). At presentation, 11.8% of patients were receiving antiplatelet and/or anticoagulant therapy. Most hernias were unilateral (74.2%) and more commonly right-sided (54.8%). Indirect hernias accounted for 50.1% of cases. The majority were reducible (91.0%) and uncomplicated (92.4%). Complications were observed in 7.6% of cases. Incarceration occurred in 4.3%, strangulation in 2.1%, and bowel obstruction in 1.3%. Perioperative Variables and Descriptive Analysis All 609 patients underwent inguinal hernia repair. The majority of procedures were performed in private hospitals (75.0%). Open repair was the predominant technique (77.2%), while laparoscopic repair accounted for 22.8% of cases. Among laparoscopic approaches, TAPP repair was performed in 18.4% of patients. Mesh repair was utilized in all cases. Prolene mesh was used in 82.9% of procedures. Prophylactic antibiotics were administered in 96.9% of patients. No intraoperative complications were reported. Urinary retention was the most common postoperative complication (4.4%). Surgical site infection occurred in 0.8%, hematoma in 2.8%, seroma in 1.6%, scrotal edema in 1.5%, hydrocele in 1.3%, and testicular complications in 0.4%. Hernia recurrence was reported in 3.3% of patients. The median operative time was 107.5 minutes (IQR: 62.5–123.75), and the median hospital stay was 1 day (IQR: 1–2 days). The median follow-up duration was 7 days (IQR: 5–16.5 days). Table 1: frequencies of categorical variable P.s. Due to missing data, denominator vary across variables Variable Category Frequency Percentages % Gender Male 581 95.4 Female 28 4.6 Total 609 100 Smoking status Smoker 447 73.4 Never 98 16.1 Ex-smoker 48 8.1 Total 593 97.4 Social status Single 51 8.4 Married 558 91.6 Total 609 100 Co-morbidities No 352 57.8 Yes 257 42.2 Total 609 100 Hypertension No 463 76.0 Yes 146 24.0 Total 609 100 Diabetes No 517 84.9 yes 92 15.1 Total 609 100 Ischemic heart disease No 562 92.3 Yes 47 7.7 Total 609 100 Heavy lifting No 533 87.5 Yes 76 12.5 Total 609 100 Past surgical history No 283 46.5 Yes 326 53.5 Total 609 100 Past groin surgery No 480 78.8 Yes 129 21.2 Total 609 100 Use of anticoagulants/anti-platelet No 537 88.2 Yes 72 11.8 Total 609 100 Type of hernia Direct 257 42.2 Indirect 305 50.1 Pantaloon 46 7.6 Total 608 99.8 Unilateral/ bilateral Unilateral 452 74.2 Bilateral 157 25.8 Total 609 100 Right or left Right 334 54.8 Left 275 45.2 Total 609 100 Reducible/ irreducible Reducible 554 91.0 Irreducible 55 9.0 Total 609 100 Presence of complications No 563 92.4 Yes 46 7.6 Total 609 100 Incarceration No 583 95.7 Yes 26 4.3 Total 609 100 Obstruction No 601 98.7 Yes 8 1.3 Total 609 100 Strangulation No 596 97.9 Yes 13 2.1 Total 609 100 Name of hospital Governmental 152 25.0 Private 457 75.0 Total 609 100 Type of procedure Open 470 77.2 Laparoscopic 139 22.8 Total 609 100 Laparoscpic Approach TAPP 112 18.4 TEP 27 4.4 NOT APPLICABLE 469 77.0 Total 609 99.8 Mesh used yes 609 100 Mesh type Prolene 505 82.9 polypropylene 27 4.4 3D mesh 76 12.5 Total 608 99.8 Use of prophylactic antibiotic No 19 3.1 Yes 590 96.9 Total 609 100 Intra operative complications No 609 100 Nausea and vomiting No 605 99.3 Yes 4 0.7 Total 609 100 Urinary retention No 582 95.6 Yes 27 4.4 Total 609 100 Outcomes / complications No 530 87.0 One complication 72 11.8 Two complications 6 1.0 Three complications 1 0.2 Total 609 100 Surgical site infection No 604 99.2 Yes 5 0.8 total 609 100 Hematoma No 592 97.2 Yes 17 2.8 Total 609 100 Seroma No 599 98.4 Yes 10 1.6 Total 609 100 Mesh infection No 609 100 Yes 0 0.0 Total 609 100 Scrotal edema No 600 98.5 Yes 9 1.5 Total 609 100 Testicular complications No 608 99.8 Yes 1 0.4 total 609 100 Recurrence of hernia No 601 96.7 Yes 7 1.15 Total 608 99.8 Confirmed of recurrence No 605 99.3 Yes 1 0.2 Total 606 99.5 Post op pain No 589 96.7 Yes 20 3.3 Total 609 100 Hydrocele No 601 98.7 Yes 8 1.3 Total 609 100 Other complications No 482 79.1 Yes 10 1.6 Total 492 80.8 Table 2: continuous variable descriptive Variable Median Interquartile ranges (IQ) Age(years) 64.5 51.25-74.0 Symptoms duration of hernia in months 12 2-36 Preoperative pain out of 10 1.0 0-2 Postoperative pain 0 0-2 Length of hospital stay in days 1 1-2 Last follow up in days 7 5-16.5 Duration of surgery in minutes 107.5 62.5-123.75 Comparing outcomes of open and laparoscopic approaches of inguinal hernia repair with mesh An association analysis was performed to evaluate the relationship between categorical clinical variables and the type of surgical approach (open versus laparoscopic repair) using the Chi-square test, with Fisher’s exact test applied when appropriate. Continuous variables were compared using the Mann–Whitney U test. The type of inguinal hernia (direct, indirect, and pantaloon) was significantly associated with the surgical approach (p = 0.037). Direct hernias were relatively more frequent in the laparoscopic group (50.0%), whereas indirect hernias were more commonly managed with open repair (53.0%). Hernia reducibility demonstrated a strong statistically significant association with the type of surgery (p < 0.001). Irreducible hernias were predominantly managed with open repair (11.3% vs. 1.4%), whereas laparoscopic repair was more frequently performed in reducible cases (98.6%). The presence of complications was significantly associated with the surgical approach (p = 0.006), with complicated hernias more commonly treated using open repair (9.1% vs. 2.2%). Strangulation showed a statistically significant association with the surgical approach based on Fisher’s exact test (p = 0.047), as all strangulated cases were treated with open repair and none underwent laparoscopic repair. Postoperative nausea and vomiting were significantly associated with the type of surgery (p = 0.039), occurring more frequently in the laparoscopic group (2.2% vs. 0.2%). Urinary retention was also significantly associated with surgical approach (p = 0.015), with most cases occurring following open repair (5.5% vs. 0.7%). Postoperative overall complications were not significantly associated with the type of surgery (p = 0.572). Regarding continuous variables, age differed significantly between the two groups (Mann–Whitney U test, p = 0.001), with a median age of 55 years (IQR: 41–66) in the open repair group and 51.5 years (IQR: 38–59) in the laparoscopic group. Similarly, the duration of surgery was significantly different between the two approaches (Mann–Whitney U test, p = 0.0011), with a median duration of 113 minutes (IQR: 88–140) for open repair and 101.5 minutes (IQR: 78–124.5) for laparoscopic repair. All other variables not mentioned demonstrated no statistically significant association with the type of surgery (p > 0.05). Table 3: association between categorical and type of surgery (chi-square/Fisher test) Variable Open herniorrhaphy N(%) Laparoscopic herniorrhaphy N(%) Total P-value Type of inguinal hernia Direct 188 (40.0) 69 (50.0) 257 (42.3) 0.037 Indirect 249 (53.0) 56 (40.6) 305 (50.2) Pantaloon 33 (7.0) 13 (9.4) 46 (7.6) Reducible_Irreducible Reducible 417 (88.7) 137 (98.6) 554 (91.0) <0.001 Irreducible 53 (11.3) 2 (1.4) 55 (9.0) Presence of complication No 427 (90.9) 136 (97.8) 563 (92.4) 0.006 Yes 43 (9.1) 3(2.2) 46 (7.6) strangulation No 457 (97.2) 139 (100) 596 (97.9) 0.047 Yes 13 (2.8) 0 (0) 13(2.1) Nausea and vomiting No 469 (99.8) 136 (97.8) 605 (99.3) 0.039 Yes 1 (0.2) 3 (2.2) 4 (0.7) Urinary retention No 444 (94.5) 138 (99.3) 582 (95.6) 0.015 Yes 26 (5.5) 1 (0.7) 27 (4.4) Post operative complication No 411(87.4) 119(85.6) 530 (87.0) 0.572 Yes 59(12.6) 20(14.4) 79(13.0) Recurrence of hernia No 465(98.9) 136(98.6) 601(98.8) 0.709 Yes 5(1.1) 2(1.4) 7(1.15) Table 4: Type of surgery and Continuous variables were compared using the Mann–Whitney U test. Variable Open median (IQ) Laparoscopic median (IQ) P VALUE AGE 55(41-66) 51.5(38-59) 0.001 Duration of surgery_min 113(88-140) 101.5(78-124.5) 0.0011 Multivariable logistic regression: Multivariable logistic regression analysis was performed to identify factors associated with postoperative complications after inguinal hernia repair with mesh . The type of surgical approach (open versus laparoscopic) was not significantly associated with postoperative complications after adjustment for potential confounders (adjusted OR 1.22, 95% CI 0.07–20.18; p=0.890). Similarly, age, sex, smoking status, marital status, heavy lifting, hypertension, diabetes mellitus, ischemic heart disease, past surgical history, previous groin surgery, symptom duration, anticoagulant or antiplatelet use, hernia type, laterality, unilateral versus bilateral disease, reducibility, hospital, operative technique subtype, mesh type, prophylactic antibiotic use, and postoperative pain score were not significantly associated with postoperative complications (all p>0.05). The presence of comorbidities was the only variable significantly associated with postoperative complications (adjusted OR 0.52, 95% CI 0.29–0.93; p=0.028). Preoperative pain score demonstrated a borderline association with postoperative complications (adjusted OR 1.17, 95% CI 0.99–1.40; p=0.070). Variables related to incarceration, obstruction, and strangulation produced unstable estimates due to sparse data and therefore, were not considered reliable predictors in the model. Table 5: Multivariable logistic regression analysis of factors associated with postoperative complications after mesh repair of inguinal hernia Variable Adjusted OR 95% CI p value Type of procedure (open vs laparoscopic) 1.22 0.07 – 20.18 0.890 Age (years) 0.998 0.975 – 1.022 0.876 Male sex 0.62 0.13 – 2.88 0.537 Smoking status (overall) — — 0.287 Current vs never smoker 1.89 0.59 – 6.02 0.284 Ex-smoker vs never smoker 2.94 0.77 – 11.25 0.115 Married 0.59 0.14 – 2.51 0.471 Heavy lifting history 1.27 0.52 – 3.10 0.601 Presence of comorbidities 0.52 0.29 – 0.93 0.028 Hypertension 0.99 0.48 – 2.07 0.980 Diabetes mellitus 1.35 0.57 – 3.17 0.495 Ischemic heart disease 0.64 0.21 – 1.90 0.418 Previous surgery (any type) 0.73 0.37 – 1.47 0.378 Previous groin surgery 1.07 0.51 – 2.25 0.857 Duration of symptoms (months) 1.00 0.995 – 1.007 0.811 Preoperative pain score (/10) 1.17 0.99 – 1.40 0.070 Anticoagulant/antiplatelet use 1.21 0.42 – 3.51 0.722 Type of inguinal hernia 0.95 0.61 – 1.49 0.829 Right vs left hernia 0.83 0.48 – 1.44 0.508 Unilateral vs bilateral 0.99 0.43 – 2.26 0.974 Reducible vs irreducible 0.44 0.10 – 1.91 0.273 Hospital 1.70 0.53 – 5.44 0.372 TAPP/TEP approach 0.88 0.21 – 3.60 0.856 Mesh type 0.89 0.52 – 1.50 0.652 Prophylactic antibiotic use 0.44 0.11 – 1.80 0.256 Postoperative pain score (/10) 1.61 0.83 – 3.14 0.161 Discussion As observed in the result section, a statistically significant association was found between type of surgery and type of inguinal hernia, with Direct hernias were more frequently treated using the laparoscopic approach, whereas indirect hernia being operate more with open approach, this is consistent with previous studies which supports the use of laparoscopic technique in direct hernia more frequently because it is arise from weakness of posterior wall of inguinal canal, making them more suitable for placement of posterior mesh by laparoscopic technique, as laparoscopic allows better visualization of myopectinal orifice enabling precise reinforcement of the posterior wall. Also, direct hernia more commonly occurred with bilaterally, and laparoscopic had a wide visualization to reveal occult contralateral defects 1,5 . In contrast, indirect inguinal hernia in our cohort study was more commonly treated with an open approach; this trend is consistent with other studies, which show that indirect hernia occurs through the deep inguinal ring and may extend into the inguinal canal or scrotum. So large inguinoscrotal hernia, longstanding sac, and cases with severe adhesion can increase surgical technique difficulties and make the open approach more frequently used. 1 Patients presenting with complicated hernias ( incarceration, obstruction, and strangulation) were significantly more likely to undergo open repair. This is consistent with previous international studies and guidelines, which recommend open surgery in complicated cases due to the need for rapid access, assessment of bowel viability, and possible resection. However, laparoscopic repair may be feasible in selected cases; it is less commonly performed in emergency situations due to technical difficulties and concerns about pneumoperitoneum in compromised bowel 1 . Similarly, Irreducible inguinal hernia were significantly more treated with an open approach, which is consistent with previous studies, which report that irreducible hernia are more treated with open than laparoscopic herniorrhaphy 15 . This may be due to limited laparoscopic expertise and technical challenges in managing an irreducible inguinal hernia via laparoscopy. As for a strangulated hernia, it is compatible with the irreducible hernia in management. However, in our study, we found that all patients with strangulation underwent open repair. This may be because time is critical, the operation must be performed as quickly as possible, allowing direct visualization and immediate management of bowel ischemia if present. This is more feasible with an open approach, especially since we do not have adequate facilities to prepare a laparoscopic theatre rapidly, nor sufficient surgical expertise for urgent laparoscopy 1,15 . The overall postoperative complication (nausea and vomiting, urinary retention, surgical site infection, hematoma, seroma, mesh infection, scrotal edema, testicular complication, recurrence of hernia) was low and not significantly different between open and laparoscopic repair (12.6% vs. 14.4%, p = 0.572), which demonstrates the acceptable safety profile of both techniques. These findings are consistent with recent studies, which document comparable complication rates between open and laparoscopic hernia repair with mesh 14 . Despite a similar overall rate, some complications are particular to each surgical procedure. Urinary retention was significantly more common with open procedures( p= 0.015), which may be related to the use of spinal anesthesia, age, and postoperative pain. So multiple previous studies show that the age and spinal anaesthesia increase the risk of urinary retention in open inguinal hernia repair. On the other hand, nausea and vomiting were more frequent with the laparoscopic procedures ( p=0.039) as they attributed more attributes to pneumoperitoneum, peritoneal stretching, and the routine use of general anesthesia, which are established as causes of nausea and vomiting 1,14 . In the current study, the overall recurrence rate was 1.2%, with 1.1% in the open group and 1.4% in the laparoscopic group. Although there was a slightly higher recurrence rate in the laparoscopic group, this was not statistically significant. This rate is consistent with the internationally reported recurrence rates of 1-5% for mesh repairs 16,17 . However, the median follow-up period of 7 days is not sufficient to assess the true recurrence rate, as recurrence usually takes months to years after surgery. Long-term follow-up studies have demonstrated that the recurrence rate increases with longer follow-up periods, with rates of 2-4% for both open and laparoscopic repairs 18,19 . Thus, although our early recurrence rate seems acceptable, it is necessary to have long-term follow-up to assess the durability of the repair. Future studies should have long-term follow-up to determine the true recurrence rate. Also in this study, patient age was significantly associated with the choice of surgical technique. This is in line with new findings that show laparoscopic surgery is more often performed on younger which the median age of 51.5 (IQR 38-59), or more physiologically fit individuals, while open surgery is more often performed on older patients with a median age of 55 (IQR 41-66). Patients selected for laparoscopic surgery were, on average, younger than those undergoing open surgery, based on a recent nationwide study of elective inguinal hernia repairs 12 . The benefits of minimally invasive repair in older age groups have also been supported by recent studies that focus exclusively on geriatric patients. Laparoscopic inguinal hernia repair was associated with faster recovery and reduced postoperative and chronic pain without increasing the risk of complications, even in older patients, in a randomised controlled trial of patients aged ≥65 20 . Taken together, these findings suggest that while age may be a factor in surgical practice, the safety and efficacy of older patients with laparoscopic repair are being increasingly recognised. Thus, in formulating the most effective surgical plan, patient selection based on biological age and overall health status, rather than simply chronological age, is necessary. Unexpectedly and contrary to most previous studies, the open hernia mesh repair group required longer median operative time when compared to the laparoscopic hernia repair group (p = 0.001), meaning that open surgery took longer operative time (min). One possible reason for this difference could be that the open approach in our setting could be more complicated as compared to the laparoscopic approach because it involves more tissue manipulation, it has a larger incision, and is used more in complicated and irreducible hernias. Secondly, the laparoscopic approach in our institution could be improved by optimized minimally invasive techniques and skilled personnel that could make it even shorter despite its technical challenge. Comparatively, some more recent studies have shown that the operating time required for laparoscopic repair may be longer than that required by open repair. For example, a randomized controlled trial found that the mean operative time for laparoscopic inguinal hernia repair was significantly longer than for open mesh repair 21 . On the other hand, results from a large cohort of 107073 patients showed that, while laparoscopic repair took longer than open repair under local anesthesia, the difference was slight under general anesthesia. (13) Although most randomized controlled trials report longer operative durations for laparoscopic repair, operative time is highly dependent on surgeon experience, case selection, and anesthesia type. In this multicenter retrospective cohort study evaluating outcomes after mesh repair of inguinal hernia, we found that the type of surgical approach (open versus laparoscopic) was not independently associated with postoperative complications after adjustment for demographic, clinical, and operative variables. This finding suggests that both techniques provide comparable short-term safety profiles when mesh repair is performed appropriately. (22) Several previous studies and systematic reviews have similarly reported no significant difference in overall postoperative complication rates between open and laparoscopic inguinal hernia repair , although laparoscopic approaches may offer advantages in postoperative recovery and chronic pain reduction in selected patients. (23,24) International hernia management guidelines also support a tailored approach to surgical technique selection , emphasizing that the choice between open and laparoscopic repair should be based on patient characteristics, hernia features, surgeon expertise, and available resources rather than on expectations of major differences in complication rates alone. (22) In the present study, comorbidity status emerged as the only factor significantly associated with postoperative complications in the multivariable model . Interestingly, the presence of comorbidities was associated with lower odds of postoperative complications . Although this finding reached statistical significance, it should be interpreted with caution because it contrasts with most surgical literature, where comorbid conditions are typically associated with increased postoperative risk. (25) One possible explanation for this observation is that patients with known comorbidities may have undergone more careful preoperative assessment, perioperative optimization, and postoperative monitoring , which may have mitigated complication risk. Alternatively, the finding may reflect residual confounding or selection bias inherent to retrospective observational studies . (26) Preoperative pain score demonstrated a borderline association with postoperative complications , suggesting that patients presenting with higher baseline symptom burden may represent a subgroup with more advanced disease or more complex operative conditions. Although this association did not reach statistical significance in the adjusted model, it may warrant further investigation in larger prospective cohorts. (27) Another important observation is the wide confidence interval observed for the procedure type variable , which indicates limited precision in estimating the true effect of surgical approach on postoperative complications. This may reflect relatively low event rates and sample size limitations , which are common challenges in observational surgical studies evaluating postoperative outcomes. (26) Overall, our findings suggest that patient-related factors may play a greater role than operative approach alone in determining postoperative outcomes after inguinal hernia repair . Consequently, individualized surgical decision-making that incorporates patient risk profile, hernia characteristics, and surgeon experience remains essential for optimizing outcomes. Limitations and strengths of the study The current multicentre retrospective cohort study offers recent real-world surgical data for a comparison between open and laparoscopic inguinal hernia repair. One of the key strengths of the study is the fact that it has a fairly large number of participants (n = 609), which helps to make the results more robust. The fact that it is a multicentre study helps to increase its generalizability. Another strength is that mesh repair was used in all cases, which helps to standardize the procedure according to the recent international guidelines for groin hernia repair, which recommend mesh repair as the standard of care. The study takes into account a wide range of perioperative parameters, which helps to assess the data in terms of operative time, early postoperative complications, and length of stay, which are considered to be short-term quality indicators in hernia surgery. However, there are a few limitations that need to be considered. The retrospective and non-randomized nature of the study may pose a risk of selection bias, where surgical technique could have been affected by patient factors, the complexity of the hernia, and the surgeon’s skill. The imbalance in the number of patients in both groups (open surgery 77% vs. laparoscopic 23%) is likely due to institutional preference and resource availability. Additionally, the median follow-up period of 7 days is too short to allow evaluation of long-term outcomes such as recurrence and chronic postoperative inguinal pain, which are major determinants of success following groin hernia repair. Missing values in certain variables may also have impacted the accuracy of the analysis. Also, we couldn’t accurately evaluate chronic pain in patients, and didn’t make a cost analysis between the two approaches. Although multivariable logistic regression was performed, residual confounding cannot be excluded. Concerning multivariable logistic regression, variables related to incarceration, obstruction, and strangulation produced unstable regression estimates due to sparse event counts (quasi-complete separation) and were therefore interpreted cautiously. Prospective studies with longer follow-up periods are needed for the assessment of rates of recurrence, chronic pain, functional results, and cost analysis. Conclusion This large retrospective cohort study of 609 patients provides a comprehensive comparison of the differences in outcomes between open and laparoscopic inguinal hernia repair with mesh. Open repair was the predominant technique, accounting for more than three-quarters of cases, while laparoscopic repair was performed in a selected subset of patients. Significant associations were observed between surgical type approach and hernia characteristics. Laparoscopic repair was more frequently performed in direct and reducible hernias and in patients without complications, whereas open repair was more commonly used in indirect, irreducible, strangulated, and complicated hernias. Patients undergoing laparoscopic repair were significantly younger, and the laparoscopic approach was associated with a shorter operative duration. Overall postoperative complication rates were low and comparable between the two techniques, and recurrence rates were minimal with no significant difference between groups. Urinary retention occurred more frequently after open repair, while nausea and vomiting were more common following laparoscopic repair. Taken together, both open and laparoscopic mesh repair showed favourable safety profiles and excellent short-term outcomes. These findings support the use of either approach depending on clinical presentation, surgeon expertise, institutional resources, and operative planning, with both techniques offering safe and effective repair. Further studies are needed to compare the cost of the two surgeries, the need for drain insertion, and the surgeon’s experience, which is recommended to enhance surgical decision-making in the Palestinian hospital. Declarations Ethics approval and consent to participate Ethical approval for this study was obtained from the Institutional Review Board (IRB) of the Arab American University. Due to the retrospective nature of the study and the use of anonymized patient data, the requirement for informed consent was waived. All methods were carried out in accordance with relevant guidelines and regulations. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This research received no external funding. Clinical trial number Not applicable. Contributions: The concept behind this retrospective cohort study originated from Husam Abualwafa. The study design and research hypothesis were developed by Iyad Ballas. Data organization and preparation for analysis were carried out by Ibrahim Alshaer. Data collection sheets were developed based on previously published studies and adapted to fit the objectives of the current retrospective cohort study. Data collection from medical records across the participating hospitals was carried out by all authors, mainly Ibrahim Aljamal and Ahmad Tahboub. Data entry and database organization were performed by Husam, Iyad, and Ibrahim Alshaer. Statistical analysis was conducted by all students. Interpretation of the results was performed collaboratively by all students. Manuscript writing and literature reviews were completed by all students. Dr. Mahdi Aljamal & Dr. Saja Nazzal supervised the whole process from the research idea to the final manuscript. All authors approved the final version of the manuscript and take responsibility for its content. Acknowledgement We extend our deepest gratitude to our supervisor for their mentorship, guidance, and continuous encouragement, which greatly facilitated the completion of this study. We are also grateful to the faculty, staff, and hospital teams at Jenin Governmental Hospital, Ibn Sina Specialized Hospital, and Al-Makassed Hospital for their support in providing access to data and resources. We sincerely thank all study participants for their time and cooperation. Finally, we acknowledge our families, friends, and colleagues for their constant support, motivation, and belief in us throughout this journey — your encouragement has been a driving force behind this work. References Stabilini C, van Veenendaal N, Aasvang E, Agresta F, Aufenacker T, Berrevoet F, et al. Update of the international HerniaSurge guidelines for groin hernia management. BJS Open. 2023;7(5):zrad080. 10.1093/bjsopen/zrad080 . Somuncu S, Somuncu ÖS. A comprehensive review: molecular and genetic background of indirect inguinal hernias. Visc Med. 2021;37(5):349–57. 10.1159/000515275 . Huerta S, Garza AM. A systematic review of open, laparoscopic, and robotic inguinal hernia repair: management of inguinal hernias in the 21st century. J Clin Med. 2025;14(3):990. 10.3390/jcm14030990 . WIB O GEN. Inguinal Hernia. A Review. J Surg Operative Care. 2016;1(2). 10.15744/2455-7617.1.202 . Tigora A, Radu PA, Garofil DN, Bratucu MN, Zurzu M, Paic V, et al. Modern perspectives on inguinal hernia repair: a narrative review on surgical techniques, mesh selection and fixation strategies. J Clin Med. 2025;14(14):4875. 10.3390/jcm14144875 . Abebe MS, Tareke AA, Alem A, Debebe W, Beyene A. Worldwide magnitude of inguinal hernia: systematic review and meta-analysis of population-based studies. SAGE Open Med. 2022;10:20503121221139150. 10.1177/20503121221139150 . Lwin ZMT, Forsberg B, Keel G, Beard JH, Amoako J, Ohene-Yeboah M, et al. Economic evaluation of expanding inguinal hernia repair among adult males in Ghana. PLOS Global Public Health. 2022;2(4):e0000270. 10.1371/journal.pgph.0000270 . Paduraru DN, Palcau AC, Ion D, Seicaru R. Multimodal prehabilitation for hernia repair: linking metabolic modulation and mechanical methods. Biomedicines. 2025;13(12):3117. 10.3390/biomedicines13123117 . Haladu N, Alabi A, Brazzelli M, Imamura M, Ahmed I, Ramsay G, et al. Open versus laparoscopic repair of inguinal hernia: an overview of systematic reviews of randomized controlled trials. Surg Endosc. 2022;36(7):4685–700. 10.1007/s00464-022-09161-6 . Alharthi M, Almontashri AI, Alsharif RH, Mozahim SF, Alyazidi LK, Ghunaim M, et al. Outcomes of open versus laparoscopic technique in primary inguinal hernia repair: a retrospective study. Cureus. 2023;15(10):e46419. 10.7759/cureus.46419 . Lillo-Albert G, Villa EB, Boscà-Robledo A, Carreño-Sáenz O, Bueno-Lledó J, Martínez-Hoed J, et al. Chronic inguinal pain post-hernioplasty: laparo-endoscopic surgery vs Lichtenstein repair: systematic review and meta-analysis. Hernia. 2024;28(4):1427–39. 10.1007/s10029-024-03077-x . Meier J, Stevens A, Berger M, Makris KI, Bramos A, Reisch J, et al. Comparison of postoperative outcomes of laparoscopic vs open inguinal hernia repair. JAMA Surg. 2023;158(2):172–80. 10.1001/jamasurg.2022.6616 . Fingerhut A, Go P, Grant AM, Kingsnorth A, Merello J, O’Dwyer P, et al. Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Reviews. 2010;1:CD001785. 10.1002/14651858.CD001785 . Yang C, Deng S. Laparoscopic versus open mesh repair for the treatment of recurrent inguinal hernia: a systematic review and meta-analysis. Annals Cardiothorac Surg. 2020;9(3):1164–73. 10.21037/apm-20-968 . Birindelli A, Sartelli M, Di Saverio S, Coccolini F, Ansaloni L, van Ramshorst GH, et al. 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias. World J Emerg Surg. 2017;12:37. 10.1186/s13017-017-0149-y . Schmidt L, Öberg S, Andresen K, Rosenberg J. Recurrence rates after inguinal hernia repair in women: a systematic review. PROSPERO. 2017:CRD42017081152. Available from: https://www.crd.york.ac.uk/PROSPERO/view/CRD42017081152 Lund H, Spanager L, Winther ACR, Gierløff M, Sunekær K, Kleif J, et al. Recurrence and complications after laparoscopic inguinal hernia repair using a self-adherent mesh: a patient-reported follow-up study. Surg Endosc. 2025;39(4):2464–70. 10.1007/s00464-025-11614-7 . Nikkolo C, Lillsaar T, Vaasna T, Kirsimägi Ü, Lepner U. Ten-year results of inguinal hernia open mesh repair. J Abdom Wall Surg. 2025;4:14384. 10.3389/jaws.2025.14384 . Beard JH, Ohene-Yeboah M, Kasu ES, Affram N, Tabiri S, Amoako JKA, et al. Long-term outcomes following inguinal hernia repair with mesh performed by medical doctors and surgeons in Ghana. Annals Surg Open. 2024;5(3):e460. 10.1097/as9.0000000000000460 . Ulutas ME, Yilmaz AH. Comparison of open and laparoscopic inguinal hernia repair in elderly patients: a randomized controlled trial. Hernia. 2025;29(1):1–8. 10.1007/s10029-025-03368-x . Aliyeva N, Hasanov RA. Laparoscopic versus open mesh repair for inguinal hernia: a randomized controlled trial. Adv J Biomed Med. 2025;3:25. 10.18081/ajbm.2025.3.197 . Simons MP, Smietanski M, Bonjer HJ, Bittner R, Miserez M, Aufenacker T, et al. International guidelines for groin hernia management. Hernia. 2018;22(1):1–165. 10.1007/s10029-017-1668-x . Aiolfi A, Cavalli M, Micheletto G, Lombardo F, Bonitta G, Morlacchi A, et al. Primary inguinal hernia: systematic review and Bayesian network meta-analysis comparing open, laparoscopic transabdominal preperitoneal, totally extraperitoneal, and robotic preperitoneal repair. Hernia. 2019;23(3):473–84. 10.1007/s10029-019-01964-2 . Bittner R, Schwarz J. Inguinal hernia repair: current surgical techniques. Langenbecks Arch Surg. 2012;397(2):271–82. 10.1007/s00423-011-0875-7 . Turrentine FE, Wang H, Simpson VB, Jones RS. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg. 2006;203(6):865–77. 10.1016/j.jamcollsurg.2006.08.026 . von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344–9. 10.1016/j.jclinepi.2007.11.008 . Poobalan AS, Bruce J, King PM, Chambers WA, Krukowski ZH, Smith WC. Chronic pain and quality of life following open inguinal hernia repair. Br J Surg. 2001;88(8):1122–6. 10.1046/j.0007-1323.2001.01828.x . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 09 May, 2026 Reviews received at journal 03 May, 2026 Reviewers agreed at journal 02 May, 2026 Reviewers agreed at journal 30 Apr, 2026 Reviewers agreed at journal 31 Mar, 2026 Reviewers invited by journal 31 Mar, 2026 Editor invited by journal 17 Mar, 2026 Editor assigned by journal 14 Mar, 2026 Submission checks completed at journal 14 Mar, 2026 First submitted to journal 10 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9087670","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":616041367,"identity":"aaba7dd2-264e-4881-9f0d-a853d595ee60","order_by":0,"name":"Iyad M. Ballas","email":"","orcid":"","institution":"Arab American University","correspondingAuthor":false,"prefix":"","firstName":"Iyad","middleName":"M.","lastName":"Ballas","suffix":""},{"id":616041368,"identity":"f5199201-25af-4da5-a968-48a3345464d9","order_by":1,"name":"Husam N. Abualwafa","email":"","orcid":"","institution":"Arab American University","correspondingAuthor":false,"prefix":"","firstName":"Husam","middleName":"N.","lastName":"Abualwafa","suffix":""},{"id":616041369,"identity":"45f5f3db-9a8e-438d-b7f9-4fbcd02283c4","order_by":2,"name":"Ibrahim H. AL-Shaer","email":"","orcid":"","institution":"Arab American University","correspondingAuthor":false,"prefix":"","firstName":"Ibrahim","middleName":"H.","lastName":"AL-Shaer","suffix":""},{"id":616041370,"identity":"c3c138ac-671a-4352-833a-23ef58ed06b4","order_by":3,"name":"Ibrahim Aljamal","email":"","orcid":"","institution":"Al-Makassed Islamic Charitable Society Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ibrahim","middleName":"","lastName":"Aljamal","suffix":""},{"id":616041371,"identity":"9b2d4be9-5537-4d28-bb92-7f590d70d164","order_by":4,"name":"Ahmed Tahboub","email":"","orcid":"","institution":"An-Najah National University","correspondingAuthor":false,"prefix":"","firstName":"Ahmed","middleName":"","lastName":"Tahboub","suffix":""},{"id":616041372,"identity":"2ec263a9-29a6-446d-a6dd-93261c9c9c0f","order_by":5,"name":"Saja Nazzal","email":"","orcid":"","institution":"Arab American University","correspondingAuthor":false,"prefix":"","firstName":"Saja","middleName":"","lastName":"Nazzal","suffix":""},{"id":616041373,"identity":"46a5b710-bb0b-4fe3-85c8-899414a71f6c","order_by":6,"name":"mahdi aljamal","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+UlEQVRIiWNgGAWjYFACHgaJBAYGGcYGIPtBBVyQsBYesJaEM8RqgatJbCNCi2772YM3HjDY8TC3n078kDjPTt7gdgPjg7dtuLWYnclLtkhgSOZh7MndLJG4Ldlww50DzIZz8Wk5kGMG9Asz0C+5G4BamBk33Ehgk+bFp+X8G5CWeh7G/rebfyTOqbcHamH/jVfLDbAth3kYZ+Ruk0hsOJwIsoUZv5Y3xhYJBseBWt5us0g4djx55p2DzZJzzuFzWI7hzR8V1XKG/bmbb3yoqbbtu9188MObMtxaIMCAgcGwAcaRYGzArRIZyMNZEsRpGAWjYBSMgpEDAOVWVUYrfc8bAAAAAElFTkSuQmCC","orcid":"","institution":"Arab American University","correspondingAuthor":true,"prefix":"","firstName":"mahdi","middleName":"","lastName":"aljamal","suffix":""}],"badges":[],"createdAt":"2026-03-10 20:53:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9087670/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9087670/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106227055,"identity":"8ed3e8e4-3302-4571-9027-96512cf969fa","added_by":"auto","created_at":"2026-04-06 11:27:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3666096,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9087670/v1/97f7d2ef-b5fc-4f7a-a3f5-5f4deac1231b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical outcomes of open versus laparoscopic inguinal hernia mesh repair in Palestine: a multicenter retrospective cohort study","fulltext":[{"header":"Background","content":"\u003cp\u003eAn inguinal hernia is the protrusion of abdominal content through a defect in the abdominal wall into the inguinal canal \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. An indirect hernia occurs when abdominal contents protrude through the internal ring\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e and follow the inguinal canal, and a direct hernia occurs when the abdominal content pushes directly through a weakened area of the posterior wall of the inguinal canal \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Globally, 20\u0026nbsp;million inguinal hernia operations are performed annually, making it the most frequently repaired by surgical approach \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. It is approximately 75% from all abdominal wall hernias and occurs more frequently in males (27%) than in females (3%) \u003csup\u003e6\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe large number of hernia repair procedures significantly contributes to healthcare resource utilization and economic costs, and exceeds 3\u0026nbsp;billion euros annually in both low- and high-income settings \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Although inguinal hernia repair is regarded as a routine surgical procedure, there is ongoing debate about the most effective surgical approach (open, laparoscopic, robotic), taking into account outcomes, cost, and patient-specific factors \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eLiterature Review\u003c/p\u003e \u003cp\u003eInguinal hernia repair is one of the most commonly performed surgical procedures worldwide. Over the past decade, open mesh repair (classically the Lichtenstein technique) and laparoscopic mesh repair (TAPP and TEP) have been the dominant operative strategies. Recent evidence and guideline updates from the European Hernia Society and the HerniaSurge Group provide current comparative insights into outcomes and technique selection\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe Lichtenstein tension-free mesh repair remains the most widely used open technique. Although originally described several decades ago, it continues to be supported as a standard approach in more recent guideline updates due to its simplicity, reproducibility, and effectiveness for primary unilateral hernias. Open repair typically involves a single groin incision and placement of a mesh over the hernia defect. It remains especially relevant in settings with limited laparoscopic resources or in patients unsuitable for laparoscopy\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eMinimally invasive approaches have increasingly been used over the last decade. The two main laparoscopic techniques are Transabdominal Preperitoneal Repair (TAPP), which involves entry into the peritoneal cavity, with dissection of the preperitoneal space. Totally Extraperitoneal Repair (TEP), which is done without entering the peritoneal cavity, minimizing intraperitoneal manipulation.\u003c/p\u003e \u003cp\u003eBoth TAPP and TEP place mesh in the preperitoneal space via small incisions. Recent comparative studies and meta-analyses demonstrate that laparoscopic approaches are associated with several perioperative benefits compared with open repair\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eBased on the studies, there were different advantages of the laparoscopic approach as patients have Less postoperative pain. Multiple randomized and observational studies report significantly reduced early postoperative pain scores in patients undergoing TAPP/TEP versus open repair. Furthermore, it was associated with Faster functional recovery. Patients tend to return to daily activities and work sooner. Its advantage is also apparent in repairing bilateral hernia. Both sides can be accessed with the same laparoscopic ports, avoiding bilateral incisions\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eDespite these advantages of the laparoscopic approach, open techniques still have multiple advantages and remain a simpler technique. Open repair is technically less complex and does not require specialized laparoscopic skills. And based on the cost, it has a lower cost. Open repair generally incurs lower direct costs due to the absence of laparoscopic equipment. And it is more suitable for complicated cases, e.g. large scrotal or strangulated hernias may be safer via open repair\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e Current evidence-based guidelines reinforce that both open and laparoscopic approaches provide effective hernia repair when performed by experienced surgeons. The European Hernia Society and HerniaSurge Group recommend that Laparoscopic approaches (TAPP/TEP) be used for bilateral and recurrent hernias due to advantages in recovery and pain outcomes. While open mesh repair (Lichtenstein) is a reliable option for primary unilateral hernias, especially where laparoscopic expertise is limited or contraindicated\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. So, the choice of technique is often influenced by patient factors and surgeon preference.\u003c/p\u003e \u003cp\u003eDespite several studies comparing open inguinal hernia repair with mesh vs laparoscopic inguinal hernia repair with mesh, A major gap and controversy still exist in the literature. Evidence regarding several outcomes is still conflicting, causing it to be difficult to show final conclusions. First, operative time appears to be variably reported across studies. Studies show that laparoscopic surgery takes longer due to the difficult and complex placement of the trocar. A recent systematic review found that laparoscopic procedures had significantly longer operative durations compared with open repair\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Likewise, complication rates are variably reported. Some evidence indicates that laparoscopic repair may lower the risk of certain wound complications and postoperative pain, it may lead to intra-abdominal and visceral injury that was not reported in the open technique\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Postoperative urinary retention, another commonly assessed outcome for hernia surgery, has shown no consistent difference between laparoscopic and open mesh repair in meta-analytic studies \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePossibly most debatable are recurrence rates. Several studies indicate that recurrence rates between laparoscopic and open mesh repairs are equivalent, especially when procedures are performed by expert surgeons; Even so, other older trials demonstrated higher recurrence with laparoscopic repairs in less expert hands\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFurthermore, major evidence arises from studies performed in Europe, the United States, and East Asia with restricted data from the Middle East and limited outcomes in specific region as in Palestine populations. This geographic discrimination emphasizes a distinct gap in knowledge, which restricts the generalizability of findings to local surgical practice and patient populations.\u003c/p\u003e \u003cp\u003eProblem statement\u003c/p\u003e \u003cp\u003eExpanding on these discrepancies, the regional context further underlines an important evidence gap. Differences in sociodemographic events, such as higher smoking rates in our cohort, could be affect postoperative complications and recurrence. Additionally, differences in hospital facilities (private versus governmental hospitals), resource availability, and surgeon experience may significantly affect the surgical endpoint. Until now, no large Palestinian cohort has directly compared open and laparoscopic mesh repair outcomes. Therefore, local evidence is essential to direct surgical judgment and healthcare policy in the region. The study aims to provide real – world data from a large Palestinian cohort.\u003c/p\u003e \u003cp\u003eStudy objectives\u003c/p\u003e\n\u003ch3\u003ePrimary objective:\u003c/h3\u003e\n\u003cp\u003e \u003c/p\u003e\u003cul\u003e \u003cli\u003e \u003cp\u003eTo compare open and laparoscopic inguinal hernia repair in terms of postoperative outcomes.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003cp\u003e\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e¬ Secondary objectives:\u003c/h2\u003e \u003cp\u003e \u003c/p\u003e\u003cul\u003e \u003cli\u003e \u003cp\u003eTo find descriptive data in patients with inguinal hernia in Palestine.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eTo assess the association between the type of surgery and postoperative complications.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eTo assess the association between the type of surgery and intraoperative complications.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eTo assess the association between the type of surgery and socio-demographic data.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy design\u003c/p\u003e \u003cp\u003eThis study was designed as a retrospective cohort study evaluating outcomes of open and laparoscopic inguinal hernia repair in three hospitals in the West Bank between January 2017 and December 2025. This study was conducted and reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.\u003c/p\u003e \u003cp\u003eStudy setting\u003c/p\u003e \u003cp\u003eThis study included three hospitals in the West Bank ( Ibn Sina Specialized Hospital, Jenin Governmental Hospital, and Makassed Islamic Charitable Hospital), two of which are private hospitals and one governmental hospital. The hospitals are located in the northern and central regions of the West Bank, ensuring representation from different healthcare sectors and geographic areas.\u003c/p\u003e \u003cp\u003eStudy population\u003c/p\u003e \u003cp\u003eWe included patients who met the inclusion criteria and were operated on with inguinal hernia repair with mesh, either open or laparoscopic surgery, from 2017 to 2025.\u003c/p\u003e\n\u003ch3\u003eInclusion criteria:\u003c/h3\u003e\n\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eAdult patients (\u0026gt;\u0026thinsp;18 years)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eDiagnosed with a primary unilateral or bilateral inguinal hernia\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eUnderwent open or laparoscopic mesh repair\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eComplete medical records, including operative notes and follow-up data were required\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e\n\u003ch3\u003eExclusion criteria:\u003c/h3\u003e\n\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003ePatient under 18 years old\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eNon- mesh repairs of inguinal hernias\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eRecurrent inguinal hernia without documented data\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eFemoral hernia\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eMissing operative data\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAny laparoscopic hernia repair converted to open repair\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eSample size\u003c/p\u003e \u003cp\u003eThis was a retrospective comparative cohort study. All adult patients who underwent inguinal hernia repair with mesh (laparoscopic or open) at [Ibn Sina specialized hospital, Jenin governmental hospital, and Makassed Islamic charitable hospital] between [1/1/2017] and [25/12/2025] were included. No a priori sample size calculation was performed because the study used total population sampling of all eligible cases during the study period.\u003c/p\u003e \u003cp\u003eData collection\u003c/p\u003e \u003cp\u003eA data collection sheet was created to include all variables related to our research (socio-demographic, clinical, preoperative, and outcomes). These data were extracted from medical records, operative reports, and clinic follow-up notes, and kept saved without name or hospital id in password protected file only accessed by the authors.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis was carried out using SPSS version 27. Descriptive statistics were employed to describe sociodemographic factors and perioperative data. Categorical variables were described using frequency and percentage. Continuous variables were described using median and interquartile range (IQR) since the data were not normally distributed, as evidenced by the Shapiro-Wilk test.\u003c/p\u003e \u003cp\u003eThe Chi-square test was employed to evaluate associations between categorical variables and the type of surgery. The Fisher\u0026rsquo;s exact test was used when the expected cell count was less than 5. The Mann-Whitney U test was employed to compare groups for continuous variables that were not normally distributed. A p-value of less than 0.05 was considered statistically significant for all tests.\u003c/p\u003e \u003cp\u003eDenominators differed for variables due to missing data.\u003c/p\u003e \u003c/div\u003e\n\u003cp\u003eEthical Approval\u003c/p\u003e\n\u003cp\u003eThe study was conducted after ethical approval from the IRB at Arab American University, before data collection. \u0026nbsp;Patient data were collected from their medical records. Each patient was given a special code, and stored without patient identifiers in password protected file, only accessed by the authors.\u003c/p\u003e"},{"header":"Result","content":"\u003ch2\u003eDescriptive analysis\u003c/h2\u003e\n\u003cp\u003eCategorical variables were presented with frequencies and percentages (table1), and continuous variables were summarized by median and interquartile ranges (IQRs) due to non-normal distribution (Table 2)\u003c/p\u003e\n\u003ch3 id=\"_Toc222544480\"\u003eSociodemographic characteristics\u003c/h3\u003e\n\u003cp\u003eA total of 609 patients were included in the study. The median age was 64.5 years (interquartile range [IQR]: 51.25\u0026ndash;74.0), with ages ranging from 18 to 80 years. The majority of participants were male (95.4%) and married (91.6%). Regarding smoking status, 73.4% of participants were smokers.\u003c/p\u003e\n\u003cp\u003eOverall, 42.2% of patients had at least one comorbidity. Hypertension was present in 24.0%, diabetes mellitus in 15.1%, and ischemic heart disease in 7.7%.\u003c/p\u003e\n\u003cp\u003eIn terms of occupational and lifestyle factors, 12.5% reported heavy lifting. A history of previous surgical procedures was noted in 53.5% of participants, and 21.2% had undergone prior groin surgery. All participants were diagnosed with an inguinal hernia and underwent surgical repair on either an elective or emergency basis.\u003c/p\u003e\n\u003ch3 id=\"_Toc222544481\"\u003eClinical Presentation Prior to Surgery\u003c/h3\u003e\n\u003cp\u003eThe median duration of symptoms was 12 months (IQR: 2\u0026ndash;36 months). The median preoperative pain score was low, with a median pain score of 1.0 out of 10 (IQR: 0\u0026ndash;2). At presentation, 11.8% of patients were receiving antiplatelet and/or anticoagulant therapy.\u003c/p\u003e\n\u003cp\u003eMost hernias were unilateral (74.2%) and more commonly right-sided (54.8%). Indirect hernias accounted for 50.1% of cases. The majority were reducible (91.0%) and uncomplicated (92.4%).\u003c/p\u003e\n\u003cp\u003eComplications were observed in 7.6% of cases. Incarceration occurred in 4.3%, strangulation in 2.1%, and bowel obstruction in 1.3%.\u003c/p\u003e\n\u003ch3 id=\"_Toc222544482\"\u003ePerioperative Variables and Descriptive Analysis\u003c/h3\u003e\n\u003cp\u003eAll 609 patients underwent inguinal hernia repair. The majority of procedures were performed in private hospitals (75.0%). Open repair was the predominant technique (77.2%), while laparoscopic repair accounted for 22.8% of cases. Among laparoscopic approaches, TAPP repair was performed in 18.4% of patients.\u003c/p\u003e\n\u003cp\u003eMesh repair was utilized in all cases. Prolene mesh was used in 82.9% of procedures. Prophylactic antibiotics were administered in 96.9% of patients.\u003c/p\u003e\n\u003cp\u003eNo intraoperative complications were reported. Urinary retention was the most common postoperative complication (4.4%). Surgical site infection occurred in 0.8%, hematoma in 2.8%, seroma in 1.6%, scrotal edema in 1.5%, hydrocele in 1.3%, and testicular complications in 0.4%. Hernia recurrence was reported in 3.3% of patients.\u003c/p\u003e\n\u003cp\u003eThe median operative time was 107.5 minutes (IQR: 62.5\u0026ndash;123.75), and the median hospital stay was 1 day (IQR: 1\u0026ndash;2 days). The median follow-up duration was 7 days (IQR: 5\u0026ndash;16.5 days).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: frequencies of categorical variable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eP.s. Due to missing data, denominator vary across variables\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"599\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentages %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e581\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95.4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e28\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking status\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoker\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e447\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e73.4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNever\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e98\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e16.1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEx-smoker\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e48\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e8.1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e593\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e97.4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial status\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSingle\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e51\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e8.4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarried\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e558\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e91.6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCo-morbidities\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e352\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e57.8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e257\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e42.2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypertension\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e463\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e76.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e146\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e24.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e517\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e84.9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eyes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e92\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e15.1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIschemic heart disease \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e562\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e92.3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e47\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeavy lifting\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e533\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e87.5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e76\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e12.5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePast surgical history\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e283\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e46.5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e326\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e53.5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePast groin surgery\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e480\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e78.8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e129\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e21.2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUse of anticoagulants/anti-platelet \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e537\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e88.2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e72\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e11.8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of hernia\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDirect\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e257\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e42.2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndirect\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e305\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e50.1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePantaloon\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e46\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e608\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e99.8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnilateral/ bilateral\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnilateral\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e452\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e74.2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBilateral\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e157\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e25.8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight or left\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e334\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e54.8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e275\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e45.2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReducible/ irreducible\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReducible\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e554\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e91.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIrreducible\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e55\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePresence of complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e563\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e92.4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e46\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncarceration\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e583\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95.7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e26\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eObstruction\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e601\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e98.7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStrangulation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e596\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e97.9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e13\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eName of hospital\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGovernmental\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e152\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e25.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrivate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e457\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e75.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of procedure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOpen\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e470\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e77.2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaparoscopic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e139\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e22.8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaparoscpic Approach\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTAPP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e112\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e18.4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTEP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e27\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNOT APPLICABLE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e469\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e77.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e99.8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMesh used\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eyes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMesh type\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProlene\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e505\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e82.9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003epolypropylene\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e27\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3D mesh\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e76\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e12.5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e608\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e99.8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUse of prophylactic antibiotic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e19\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e590\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e96.9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntra operative complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNausea and vomiting\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e605\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e99.3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUrinary retention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e582\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95.6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e27\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcomes / complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e530\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e87.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOne complication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e72\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e11.8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTwo complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThree complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurgical site infection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e604\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e99.2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003etotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHematoma\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e592\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e97.2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e17\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSeroma\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e599\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e98.4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMesh infection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eScrotal edema\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e600\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e98.5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTesticular complications\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e608\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e99.8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003etotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRecurrence of hernia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e601\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e96.7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e608\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e99.8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConfirmed of recurrence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e605\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e99.3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e606\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e99.5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost op pain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e589\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e96.7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e20\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHydrocele\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e601\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e98.7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e609\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOther complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e482\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e79.1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e492\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e80.8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: continuous variable descriptive \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"614\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInterquartile ranges (IQ)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge(years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e64.5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e51.25-74.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSymptoms duration of hernia in months\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e12\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2-36\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative pain out of 10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0-2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative pain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0-2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLength of hospital stay in days\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1-2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLast follow up in days\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5-16.5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of surgery in minutes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e107.5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e62.5-123.75\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ch2 id=\"_Toc222544483\"\u003eComparing outcomes of open and laparoscopic approaches of inguinal hernia repair with mesh\u003c/h2\u003e\n\u003cp\u003eAn association analysis was performed to evaluate the relationship between categorical clinical variables and the type of surgical approach (open versus laparoscopic repair) using the Chi-square test, with Fisher\u0026rsquo;s exact test applied when appropriate. Continuous variables were compared using the Mann\u0026ndash;Whitney U test.\u003c/p\u003e\n\u003cp\u003eThe type of inguinal hernia (direct, indirect, and pantaloon) was significantly associated with the surgical approach (p = 0.037). Direct hernias were relatively more frequent in the laparoscopic group (50.0%), whereas indirect hernias were more commonly managed with open repair (53.0%).\u003c/p\u003e\n\u003cp\u003eHernia reducibility demonstrated a strong statistically significant association with the type of surgery (p \u0026lt; 0.001). Irreducible hernias were predominantly managed with open repair (11.3% vs. 1.4%), whereas laparoscopic repair was more frequently performed in reducible cases (98.6%).\u003c/p\u003e\n\u003cp\u003eThe presence of complications was significantly associated with the surgical approach (p = 0.006), with complicated hernias more commonly treated using open repair (9.1% vs. 2.2%).\u003c/p\u003e\n\u003cp\u003eStrangulation showed a statistically significant association with the surgical approach based on Fisher\u0026rsquo;s exact test (p = 0.047), as all strangulated cases were treated with open repair and none underwent laparoscopic repair.\u003c/p\u003e\n\u003cp\u003ePostoperative nausea and vomiting were significantly associated with the type of surgery (p = 0.039), occurring more frequently in the laparoscopic group (2.2% vs. 0.2%). Urinary retention was also significantly associated with surgical approach (p = 0.015), with most cases occurring following open repair (5.5% vs. 0.7%).\u003c/p\u003e\n\u003cp\u003ePostoperative overall complications were not significantly associated with the type of surgery (p = 0.572).\u003c/p\u003e\n\u003cp\u003eRegarding continuous variables, age differed significantly between the two groups (Mann\u0026ndash;Whitney U test, p = 0.001), with a median age of 55 years (IQR: 41\u0026ndash;66) in the open repair group and 51.5 years (IQR: 38\u0026ndash;59) in the laparoscopic group.\u003c/p\u003e\n\u003cp\u003eSimilarly, the duration of surgery was significantly different between the two approaches (Mann\u0026ndash;Whitney U test, p = 0.0011), with a median duration of 113 minutes (IQR: 88\u0026ndash;140) for open repair and 101.5 minutes (IQR: 78\u0026ndash;124.5) for laparoscopic repair.\u003c/p\u003e\n\u003cp\u003eAll other variables not mentioned demonstrated no statistically significant association with the type of surgery (p \u0026gt; 0.05).\u003c/p\u003e\n\u003cp\u003eTable 3: association between categorical and type of surgery (chi-square/Fisher test)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"636\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOpen herniorrhaphy N(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaparoscopic herniorrhaphy N(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of inguinal hernia\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDirect\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e188 (40.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e69 (50.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e257 (42.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.037\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndirect\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e249 (53.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e56 (40.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e305 (50.2)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePantaloon\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e33 (7.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e13 (9.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e46 (7.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReducible_Irreducible\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReducible\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e417 (88.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e137 (98.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e554 (91.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIrreducible\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e53 (11.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2 (1.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e55 (9.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePresence of complication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e427 (90.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e136 (97.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e563 (92.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e43 (9.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3(2.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e46 (7.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003estrangulation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e457 (97.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e139 (100)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e596 (97.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.047\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e13 (2.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0 (0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e13(2.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Nausea and vomiting\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e469 (99.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e136 (97.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e605 (99.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.039\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1 (0.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3 (2.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4 (0.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUrinary retention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e444 (94.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e138 (99.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e582 (95.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.015\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e26 (5.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1 (0.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e27 (4.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost operative complication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e411(87.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e119(85.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e530 (87.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.572\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e59(12.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e20(14.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e79(13.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRecurrence of hernia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e465(98.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e136(98.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e601(98.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.709\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5(1.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2(1.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7(1.15)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Type of surgery and Continuous variables were compared using the Mann\u0026ndash;Whitney U test.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOpen median (IQ)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaparoscopic median (IQ)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP VALUE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAGE\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e55(41-66)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e51.5(38-59)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of surgery_min\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e113(88-140)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e101.5(78-124.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.0011\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch1\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/h1\u003e\n\u003ch2\u003e\u003cstrong\u003eMultivariable logistic regression:\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eMultivariable logistic regression analysis was performed to identify factors associated with \u003cstrong\u003epostoperative complications after inguinal hernia repair with mesh\u003c/strong\u003e. The \u003cstrong\u003etype of surgical approach (open versus laparoscopic)\u003c/strong\u003e was \u003cstrong\u003enot significantly associated\u003c/strong\u003e with postoperative complications after adjustment for potential confounders (adjusted OR 1.22, 95% CI 0.07\u0026ndash;20.18; p=0.890). Similarly, age, sex, smoking status, marital status, heavy lifting, hypertension, diabetes mellitus, ischemic heart disease, past surgical history, previous groin surgery, symptom duration, anticoagulant or antiplatelet use, hernia type, laterality, unilateral versus bilateral disease, reducibility, hospital, operative technique subtype, mesh type, prophylactic antibiotic use, and postoperative pain score were \u003cstrong\u003enot significantly associated\u003c/strong\u003e with postoperative complications (all p\u0026gt;0.05).\u003c/p\u003e\n\u003cp\u003eThe \u003cstrong\u003epresence of comorbidities\u003c/strong\u003e was the \u003cstrong\u003eonly variable significantly associated with postoperative complications\u003c/strong\u003e (adjusted OR 0.52, 95% CI 0.29\u0026ndash;0.93; p=0.028). Preoperative pain score demonstrated a \u003cstrong\u003eborderline association\u003c/strong\u003e with postoperative complications (adjusted OR 1.17, 95% CI 0.99\u0026ndash;1.40; p=0.070). Variables related to incarceration, obstruction, and strangulation produced unstable estimates due to sparse data and therefore, were not considered reliable predictors in the model.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5: Multivariable logistic regression analysis of factors associated with postoperative complications after mesh repair of inguinal hernia\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted OR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of procedure (open vs laparoscopic)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.07 \u0026ndash; 20.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.890\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.998\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.975 \u0026ndash; 1.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.876\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale sex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.13 \u0026ndash; 2.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.537\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking status (overall)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.287\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrent vs never smoker\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.59 \u0026ndash; 6.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.284\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEx-smoker vs never smoker\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.77 \u0026ndash; 11.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.115\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarried\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.14 \u0026ndash; 2.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.471\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeavy lifting history\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.52 \u0026ndash; 3.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.601\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePresence of comorbidities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.52\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.29 \u0026ndash; 0.93\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.028\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypertension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.48 \u0026ndash; 2.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.980\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes mellitus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.57 \u0026ndash; 3.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.495\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eIschemic heart disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.21 \u0026ndash; 1.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.418\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrevious surgery (any type)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.37 \u0026ndash; 1.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.378\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrevious groin surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.51 \u0026ndash; 2.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.857\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of symptoms (months)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.995 \u0026ndash; 1.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.811\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative pain score (/10)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.99 \u0026ndash; 1.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.070\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnticoagulant/antiplatelet use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.42 \u0026ndash; 3.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.722\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of inguinal hernia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.61 \u0026ndash; 1.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.829\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight vs left hernia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.48 \u0026ndash; 1.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.508\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnilateral vs bilateral\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.43 \u0026ndash; 2.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.974\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eReducible vs irreducible\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.10 \u0026ndash; 1.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.273\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.53 \u0026ndash; 5.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.372\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTAPP/TEP approach\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.21 \u0026ndash; 3.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.856\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMesh type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.52 \u0026ndash; 1.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.652\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eProphylactic antibiotic use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.11 \u0026ndash; 1.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.256\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative pain score (/10)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.83 \u0026ndash; 3.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.161\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eAs observed in the result section, a statistically significant association was found between type of surgery and type of inguinal hernia, with Direct hernias were more frequently treated using the laparoscopic approach, whereas indirect hernia being operate more with open approach, this is consistent with previous studies which supports the use of laparoscopic technique in direct hernia more frequently because it is arise from weakness of posterior wall of inguinal canal, making them more suitable for placement of posterior mesh by laparoscopic technique, as laparoscopic allows better visualization of myopectinal orifice\u0026nbsp;enabling precise reinforcement of the posterior wall. Also, direct hernia more commonly occurred with bilaterally, and laparoscopic had a wide visualization to reveal occult contralateral defects\u003csup\u003e1,5\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eIn contrast, indirect inguinal hernia in our cohort study was more commonly treated with an open approach; this trend is consistent with other studies, which show that indirect hernia occurs through the deep inguinal ring and may extend into the inguinal canal or scrotum. So large inguinoscrotal hernia, longstanding sac, and cases with severe adhesion can increase surgical technique difficulties and make the open approach more frequently used.\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003ePatients presenting with complicated hernias ( incarceration, obstruction, and strangulation) were significantly more likely to undergo open repair. This is consistent with previous international studies and guidelines, which recommend open surgery in complicated cases due to the need for rapid access, assessment of bowel viability, and possible resection. However, laparoscopic repair may be feasible in selected cases; it is less commonly performed in emergency situations due to technical difficulties and concerns about pneumoperitoneum in compromised bowel\u003csup\u003e1\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eSimilarly, Irreducible inguinal hernia were significantly more treated with an open approach, which is consistent with previous studies, which report that irreducible hernia are more treated with open than laparoscopic herniorrhaphy\u003csup\u003e15\u003c/sup\u003e. This may be due to limited laparoscopic expertise and technical challenges in managing an irreducible inguinal hernia via laparoscopy.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs for a strangulated hernia, it is compatible with the irreducible hernia in management. However, in our study, we found that all patients with strangulation underwent open repair. This may be because time is critical, the operation must be performed as quickly as possible, allowing direct visualization and immediate management of bowel ischemia if present. This is more feasible with an open approach, especially since we do not have adequate facilities to prepare a laparoscopic theatre rapidly, nor sufficient surgical expertise for urgent laparoscopy\u003csup\u003e1,15\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe overall postoperative complication (nausea and vomiting, urinary retention, surgical site infection, hematoma, seroma, mesh infection, scrotal edema, testicular complication, recurrence of hernia) was low and not significantly different between open and laparoscopic repair (12.6% vs. 14.4%, p = 0.572), which demonstrates the acceptable safety profile of both techniques. These findings are consistent with recent studies, which document comparable complication rates between open and laparoscopic hernia repair with mesh\u003csup\u003e14\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eDespite a similar overall rate, some complications are particular to each surgical procedure. Urinary retention was significantly more common with open procedures( p= 0.015), which may be related to the use of spinal anesthesia, age, and postoperative pain. So multiple previous studies show that the age and spinal anaesthesia increase the risk of urinary retention in open inguinal hernia repair. On the other hand, nausea and vomiting were more frequent with the laparoscopic procedures ( p=0.039) as they attributed more attributes to pneumoperitoneum, peritoneal stretching, and the routine use of general anesthesia, which are established as causes of nausea and vomiting\u003csup\u003e1,14\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eIn the current study, the overall recurrence rate was 1.2%, with 1.1% in the open group and 1.4% in the laparoscopic group. Although there was a slightly higher recurrence rate in the laparoscopic group, this was not statistically significant. This rate is consistent with the internationally reported recurrence rates of 1-5% for mesh repairs \u003csup\u003e16,17\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eHowever, the median follow-up period of 7 days is not sufficient to assess the true recurrence rate, as recurrence usually takes months to years after surgery. Long-term follow-up studies have demonstrated that the recurrence rate increases with longer follow-up periods, with rates of 2-4% for both open and laparoscopic repairs\u003csup\u003e18,19\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThus, although our early recurrence rate seems acceptable, it is necessary to have long-term follow-up to assess the durability of the repair. Future studies should have long-term follow-up to determine the true recurrence rate.\u003c/p\u003e\n\u003cp\u003eAlso in this study, patient age was significantly associated with the choice of surgical technique. This is in line with new findings that show laparoscopic surgery is more often performed on younger which the median age of 51.5 (IQR 38-59), or more physiologically fit individuals, while open surgery is more often performed on older patients with a median age of 55 (IQR 41-66). Patients selected for laparoscopic surgery were, on average, younger than those undergoing open surgery, based on a recent nationwide study of elective inguinal hernia repairs\u003csup\u003e12\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe benefits of minimally invasive repair in older age groups have also been supported by recent studies that focus exclusively on geriatric patients. Laparoscopic inguinal hernia repair was associated with faster recovery and reduced postoperative and chronic pain without increasing the risk of complications, even in older patients, in a randomised controlled trial of patients aged \u0026ge;65\u003csup\u003e20\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eTaken together, these findings suggest that while age may be a factor in surgical practice, the safety and efficacy of older patients with laparoscopic repair are being increasingly recognised. Thus, in formulating the most effective surgical plan, patient selection based on biological age and overall health status, rather than simply chronological age, is necessary.\u003c/p\u003e\n\u003cp\u003eUnexpectedly and contrary to most previous studies, the open hernia mesh repair group required longer median operative time when compared to the laparoscopic hernia repair group (p = 0.001), meaning that open surgery took longer operative time (min).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOne possible reason for this difference could be that the open approach in our setting could be more complicated as compared to the laparoscopic approach because it involves more tissue manipulation, it has a larger incision, and is used more in complicated and irreducible hernias. Secondly, the laparoscopic approach in our institution could be improved by optimized minimally invasive techniques and skilled personnel that could make it even shorter despite its technical challenge.\u003c/p\u003e\n\u003cp\u003eComparatively, some more recent studies have shown that the operating time required for laparoscopic repair may be longer than that required by open repair. For example, a randomized controlled trial found that the mean operative time for laparoscopic inguinal hernia repair was significantly longer than for open mesh repair\u003csup\u003e21\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eOn the other hand, results from a large cohort of 107073 patients showed that, while laparoscopic repair took longer than open repair under local anesthesia, the difference was slight under general anesthesia. (13) Although most randomized controlled trials report longer operative durations for laparoscopic repair, operative time is highly dependent on surgeon experience, case selection, and anesthesia type.\u003c/p\u003e\n\u003cp\u003eIn this multicenter retrospective cohort study evaluating outcomes after mesh repair of inguinal hernia, we found that the \u003cstrong\u003etype of surgical approach (open versus laparoscopic)\u003c/strong\u003e was \u003cstrong\u003enot independently associated with postoperative complications\u003c/strong\u003e after adjustment for demographic, clinical, and operative variables. This finding suggests that both techniques provide \u003cstrong\u003ecomparable short-term safety profiles\u003c/strong\u003e when mesh repair is performed appropriately. \u003cstrong\u003e(22)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeveral previous studies and systematic reviews have similarly reported \u003cstrong\u003eno significant difference in overall postoperative complication rates between open and laparoscopic inguinal hernia repair\u003c/strong\u003e, although laparoscopic approaches may offer advantages in postoperative recovery and chronic pain reduction in selected patients. \u003cstrong\u003e(23,24)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInternational hernia management guidelines also support a \u003cstrong\u003etailored approach to surgical technique selection\u003c/strong\u003e, emphasizing that the choice between open and laparoscopic repair should be based on patient characteristics, hernia features, surgeon expertise, and available resources rather than on expectations of major differences in complication rates alone. \u003cstrong\u003e(22)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the present study, \u003cstrong\u003ecomorbidity status emerged as the only factor significantly associated with postoperative complications in the multivariable model\u003c/strong\u003e. Interestingly, the presence of comorbidities was associated with \u003cstrong\u003elower odds of postoperative complications\u003c/strong\u003e. Although this finding reached statistical significance, it should be interpreted with caution because it contrasts with most surgical literature, where comorbid conditions are typically associated with increased postoperative risk. \u003cstrong\u003e(25)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOne possible explanation for this observation is that patients with known comorbidities may have undergone \u003cstrong\u003emore careful preoperative assessment, perioperative optimization, and postoperative monitoring\u003c/strong\u003e, which may have mitigated complication risk. Alternatively, the finding may reflect \u003cstrong\u003eresidual confounding or selection bias inherent to retrospective observational studies\u003c/strong\u003e. \u003cstrong\u003e(26)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePreoperative pain score demonstrated a \u003cstrong\u003eborderline association with postoperative complications\u003c/strong\u003e, suggesting that patients presenting with higher baseline symptom burden may represent a subgroup with more advanced disease or more complex operative conditions. Although this association did not reach statistical significance in the adjusted model, it may warrant further investigation in larger prospective cohorts. \u003cstrong\u003e(27)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnother important observation is the \u003cstrong\u003ewide confidence interval observed for the procedure type variable\u003c/strong\u003e, which indicates limited precision in estimating the true effect of surgical approach on postoperative complications. This may reflect \u003cstrong\u003erelatively low event rates and sample size limitations\u003c/strong\u003e, which are common challenges in observational surgical studies evaluating postoperative outcomes. \u003cstrong\u003e(26)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOverall, our findings suggest that \u003cstrong\u003epatient-related factors may play a greater role than operative approach alone in determining postoperative outcomes after inguinal hernia repair\u003c/strong\u003e. Consequently, individualized surgical decision-making that incorporates patient risk profile, hernia characteristics, and surgeon experience remains essential for optimizing outcomes.\u003c/p\u003e\n\u003cp id=\"_Toc222544485\"\u003e\u003cstrong\u003eLimitations and strengths of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe current multicentre retrospective cohort study offers recent real-world surgical data for a comparison between open and laparoscopic inguinal hernia repair. One of the key strengths of the study is the fact that it has a fairly large number of participants (n = 609), which helps to make the results more robust. The fact that it is a multicentre study helps to increase its generalizability. Another strength is that mesh repair was used in all cases, which helps to standardize the procedure according to the recent international guidelines for groin hernia repair, which recommend mesh repair as the standard of care. The study takes into account a wide range of perioperative parameters, which helps to assess the data in terms of operative time, early postoperative complications, and length of stay, which are considered to be short-term quality indicators in hernia surgery.\u003c/p\u003e\n\u003cp\u003eHowever, there are a few limitations that need to be considered. The retrospective and non-randomized nature of the study may pose a risk of selection bias, where surgical technique could have been affected by patient factors, the complexity of the hernia, and the surgeon\u0026rsquo;s skill. The imbalance in the number of patients in both groups (open surgery 77% vs. laparoscopic 23%) is likely due to institutional preference and resource availability. Additionally, the median follow-up period of 7 days is too short to allow evaluation of long-term outcomes such as recurrence and chronic postoperative inguinal pain, which are major determinants of success following groin hernia repair. Missing values in certain variables may also have impacted the accuracy of the analysis. Also, we couldn\u0026rsquo;t accurately evaluate chronic pain in patients, and didn\u0026rsquo;t make a cost analysis between the two approaches. Although multivariable logistic regression was performed, residual confounding cannot be excluded. Concerning multivariable logistic regression, variables related to incarceration, obstruction, and strangulation produced unstable regression estimates due to sparse event counts (quasi-complete separation) and were therefore interpreted cautiously.\u003c/p\u003e\n\u003cp\u003eProspective studies with longer follow-up periods are needed for the assessment of rates of recurrence, chronic pain, functional results, and cost analysis.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis large retrospective cohort study of 609 patients provides a comprehensive comparison of the differences in outcomes between open and laparoscopic inguinal hernia repair with mesh. Open repair was the predominant technique, accounting for more than three-quarters of cases, while laparoscopic repair was performed in a selected subset of patients.\u003c/p\u003e\n\u003cp\u003eSignificant associations were observed between surgical type approach and hernia characteristics. Laparoscopic repair was more frequently performed in direct and reducible hernias and in patients without complications, whereas open repair was more commonly used in indirect, irreducible, strangulated, and complicated hernias. Patients undergoing laparoscopic repair were significantly younger, and the laparoscopic approach was associated with a shorter operative duration.\u003c/p\u003e\n\u003cp\u003eOverall postoperative complication rates were low and comparable between the two techniques, and recurrence rates were minimal with no significant difference between groups. Urinary retention occurred more frequently after open repair, while nausea and vomiting were more common following laparoscopic repair.\u003c/p\u003e\n\u003cp\u003eTaken together, both open and laparoscopic mesh repair showed favourable safety profiles and excellent short-term outcomes. These findings support the use of either approach depending on clinical presentation, surgeon expertise, institutional resources, and operative planning, with both techniques offering safe and effective repair.\u003c/p\u003e\n\u003cp\u003eFurther studies are needed to compare the cost of the two surgeries, the need for drain insertion, and the surgeon\u0026rsquo;s experience, which is recommended to enhance surgical decision-making in the Palestinian hospital.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eEthical approval for this study was obtained from the Institutional Review Board (IRB) of the Arab American University. Due to the retrospective nature of the study and the use of anonymized patient data, the requirement for informed consent was waived. All methods were carried out in accordance with relevant guidelines and regulations.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003eClinical trial number\u003cbr\u003e\u0026nbsp;Not applicable.\u003c/p\u003e\n\u003ch2\u003eContributions:\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThe concept behind this retrospective cohort study originated from Husam Abualwafa. The study design and research hypothesis were developed by Iyad Ballas. Data organization and preparation for analysis were carried out by Ibrahim Alshaer.\u0026nbsp;Data collection sheets were developed based on previously published studies and adapted to fit the objectives of the current retrospective cohort study. Data collection from medical records across the participating hospitals was carried out by all authors, mainly Ibrahim Aljamal and Ahmad Tahboub. Data entry and database organization were performed by Husam, Iyad, and Ibrahim Alshaer. Statistical analysis was conducted by all students. Interpretation of the results was performed collaboratively by all students. Manuscript writing and literature reviews were completed by all students. Dr. Mahdi Aljamal \u0026amp; Dr. Saja Nazzal supervised the whole process from the research idea to the final manuscript. All authors approved the final version of the manuscript and take responsibility for its content.\u003c/p\u003e\n\u003ch2\u003eAcknowledgement\u003c/h2\u003e\n\u003cp\u003eWe extend our deepest gratitude to our supervisor for their mentorship, guidance, and continuous encouragement, which greatly facilitated the completion of this study. We are also grateful to the faculty, staff, and hospital teams at Jenin Governmental Hospital, Ibn Sina Specialized Hospital, and Al-Makassed Hospital for their support in providing access to data and resources. We sincerely thank all study participants for their time and cooperation. Finally, we acknowledge our families, friends, and colleagues for their constant support, motivation, and belief in us throughout this journey \u0026mdash; your encouragement has been a driving force behind this work.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eStabilini C, van Veenendaal N, Aasvang E, Agresta F, Aufenacker T, Berrevoet F, et al. Update of the international HerniaSurge guidelines for groin hernia management. BJS Open. 2023;7(5):zrad080. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/bjsopen/zrad080\u003c/span\u003e\u003cspan address=\"10.1093/bjsopen/zrad080\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSomuncu S, Somuncu \u0026Ouml;S. A comprehensive review: molecular and genetic background of indirect inguinal hernias. 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Br J Surg. 2001;88(8):1122\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1046/j.0007-1323.2001.01828.x\u003c/span\u003e\u003cspan address=\"10.1046/j.0007-1323.2001.01828.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Inguinal hernia, Hernia repair, Laparoscopic surgery, Open surgery, Mesh repair, Retrospective cohort, Palestine","lastPublishedDoi":"10.21203/rs.3.rs-9087670/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9087670/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Inguinal hernia repair is one of the most frequently performed surgical procedures worldwide, accounting for approximately 75% of abdominal wall hernias, and predominantly occurring in males. Although it is a common procedure with generally favourable outcomes, the postoperative outcomes, such as chronic pain, recurrence, and surgical complications, remain important concerns. Due to the large number of procedures performed worldwide and the associated healthcare costs, the assessment of surgical outcomes and the factors that affect patients’ recovery are essential to optimize management strategies and improve long-term results. The aim of this study was to evaluate postoperative outcomes after inguinal hernia repair in terms of the incidence of complications and postoperative course in an attempt to determine which approach is associated with fewer complications\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod: \u003c/strong\u003eA retrospective cohort study was conducted to compare the outcomes between open vs laparoscopic inguinal hernia mesh repair. All patients who underwent inguinal hernia mesh repair in 3 hospitals from 2017 to 2025 were collected. Patients were divided into groups based on surgical technique (open repair vs laparoscopic repair). Demographic data, operative time, length of hospital stay, postoperative complications including hematoma, seroma, wound infection, hydrocele, urinary retention, vomiting, and recurrence, were extracted and analysed. Statistical analysis was performed by using SPSS to compare outcomes between the two groups, with a P- value \u0026lt;0.05 considered statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A total of 609 patients underwent inguinal hernia repair with mesh. Open repair was more prevalent (77.2%), while laparoscopic repair represented 22.8% of cases. Laparoscopic repair was more frequently performed for direct hernias, whereas indirect hernias were more commonly treated with open repair (p = 0.037). Reducible and uncomplicated hernias were significantly associated with laparoscopic repair (p \u0026lt; 0.001, p = 0.006), while irreducible and strangulated hernias were predominantly managed with open surgery.\u003c/p\u003e\n\u003cp\u003ePatients undergoing laparoscopic repair were younger (median 51.5 vs. 55 years, p = 0.001) and had shorter operative duration (median 101.5 vs. 113 minutes, p = 0.001). Urinary retention occurred more frequently after open repair (5.5% vs. 0.7%, p = 0.015), whereas postoperative nausea and vomiting were more common following laparoscopy (2.2% vs. 0.2%, p = 0.039).\u003c/p\u003e\n\u003cp\u003eOverall postoperative complications were low and comparable between the two approaches (12.6% vs. 14.4%, p = 0.572), and recurrence rates were minimal with no significant difference between groups (1.1% vs. 1.4%, p = 0.709).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Both open and laparoscopic inguinal hernia repair demonstrated favourable safety profiles in this cohort; however, postoperative complications, such as chronic pain, remain a problem for some patients. Careful patient selection, proper surgical technique, and early recognition of risk factors may help improve postoperative outcomes. Further research is needed to improve surgical techniques and reduce postoperative morbidity.\u003c/p\u003e","manuscriptTitle":"Clinical outcomes of open versus laparoscopic inguinal hernia mesh repair in Palestine: a multicenter retrospective cohort study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-06 11:26:36","doi":"10.21203/rs.3.rs-9087670/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-09T11:35:12+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-03T13:50:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"108815954565330281994971451809598929107","date":"2026-05-02T10:50:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"282937358306506305481231711071942788686","date":"2026-04-30T20:21:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"232443188196294986692798670888700999787","date":"2026-03-31T15:26:53+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-31T14:02:14+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-17T14:22:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-14T07:42:16+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-14T07:41:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Surgery","date":"2026-03-10T20:37:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d5c04cbf-abfb-4a69-a7ae-8074e9e03f9f","owner":[],"postedDate":"April 6th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-09T11:35:12+00:00","index":86,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-03T13:50:51+00:00","index":84,"fulltext":""},{"type":"reviewerAgreed","content":"108815954565330281994971451809598929107","date":"2026-05-02T10:50:17+00:00","index":82,"fulltext":""},{"type":"reviewerAgreed","content":"282937358306506305481231711071942788686","date":"2026-04-30T20:21:02+00:00","index":80,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-06T11:26:36+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-06 11:26:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9087670","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9087670","identity":"rs-9087670","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}