title: Recurrent hernia following endoscopic total extraperitoneal repair.
abstract: OBJECTIVE
  A retrospective study was conducted to identify the reasons for recurrence following endoscopic total extraperitoneal (TEP) repair of inguinal hernias and to develop a strategy to prevent recurrence.
  
  
  METHODS
  Between January 1996 and December 2001, 1193 TEP hernia repairs were performed in 694 patients. Following reduction of the hernia sac and dissection of the preperitoneal space up to the psoas muscles laterally, a Prolene mesh (15 x 15 cm) was placed. The mesh was fixed medially to the Cooper ligament with two or three spiral tacks. In six patients, the hernia recurred following endoscopic TEP repair within the same period. Four of these patients elected to undergo laparoscopic transabdominal preperitoneal (TAPP) repair of the recurrent hernia.
  
  
  RESULTS
  Medial recurrences developed in three of the four patients because of medial displacement of the mesh. One patient was found to have a missed indirect hernia sac. All the patients who underwent laparoscopic TAPP repair had an uneventful recovery and are well at follow-up.
  
  
  CONCLUSIONS
  In addition to medial fixation of the mesh to the Cooper ligament, complete proximal dissection of the peritoneum from the spermatic cord and additional fixation of the mesh to the anterior abdominal wall, with careful avoidance of possible injury to the adjacent nerves, may prevent recurrences.
authors.affiliation: Department of Minimal Access Surgery, Sir Ganga Ram Hospital, New Delhi, India. pk_chowbey@yahoo.com
authors.forename: Pradeep K
authors.initials: PK
authors.lastname: Chowbey
authors.forename: Samik Kumar
authors.initials: SK
authors.lastname: Bandyopadhyay
authors.forename: Anil
authors.initials: A
authors.lastname: Sharma
authors.forename: Rajesh
authors.initials: R
authors.lastname: Khullar
authors.forename: Vandana
authors.initials: V
authors.lastname: Soni
authors.forename: Manish
authors.initials: M
authors.lastname: Baijal
mesh_terms: D000328:Adult; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome