A unified approach to recurrent laparoscopic hernia repairs.
BACKGROUND
The problem of recurrence after laparoscopic hernia repair is relatively new, and the best way to handle it remains uncertain. The question of whether an open approach, a laparoscopic approach, or some combination of techniques should be preferred has not yet been resolved. The purpose of this study was to determine if the laparoscopic approach could deal with the problem safely and successfully.


METHODS
A retrospective review was done of the cases performed at the Center for Hernia Repair by one surgeon between July 1991 and September 1999. Laparoscopic hernioplasties for hernias that had previously been repaired laparoscopically were analyzed. All remedial repairs were begun using a transabdominal approach.


RESULTS
Seventeen of 1960 hernias repaired were for failed laparoscopic repairs. Ten were repaired totally laparoscopically and two via an open approach with mesh, while five required a small anterior counterincision. There were no serious complications and one recurrence.


CONCLUSIONS
The laparoscopic transabdominal approach to failed laparoscopic repairs is feasible, safe, and reliable when used in combination with a modified anterior approach when appropriate.
Felix
E L
EL
Department of Surgery, University of California-Fresno and Center for Hernia Repair, Fresno, CA 93710, USA. elfelixmd@aol.com
D000328:Adult; D000368:Aged; D005260:Female; D006550:Hernia, Femoral / Q000601:surgery; D006552:Hernia, Inguinal / Q000601:surgery; D059685:Herniorrhaphy; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D013526:Surgical Mesh / Q000009:adverse effects / Q000706:statistics & numerical data