Re-recurrence after operation for recurrent inguinal hernia. A nationwide 8-year follow-up study on the role of type of repair.
OBJECTIVE
We analyze, on a nationwide basis, the risk of re-reoperation with reference to previous inguinal hernia repair technique.


BACKGROUND
Operation for a recurrent inguinal hernia is common and the risk of re-recurrence is high. There are no large-scale data evaluating the surgical strategy and results after recurrent inguinal hernia repairs.


METHODS
Prospective recording of all primary and subsequent recurrent inguinal hernia repairs from January 1, 1998 to December 31, 2005, in the national Danish Hernia Database, using the reoperation rate as a proxy for recurrence. The re-reoperation rate was analyzed with reference to the technique of primary and recurrent inguinal hernia repair.


RESULTS
After 67,306 primary hernia repairs there were 2117 reoperations (3.1%) and 187 re-reoperations (8.8%). The cumulated re-reoperation rate after primary Lichtenstein repair (n = 1124) was significantly reduced after laparoscopic operation for recurrence (1.3% (95% CI: 0.4-3.0)) compared with open repairs for recurrence (Lichtenstein 11.3% (8.2-15.2), nonmesh 19.2% (14.0-25.4), mesh (non-Lichtenstein) 7.2% (4.0 - 11.8)). After primary nonmesh (n = 616), non-Lichtenstein mesh (n = 277), and laparoscopic repair (n = 100) there was no significant difference in re-reoperation rates between a laparoscopic repair and all open techniques of repair for recurrence.


CONCLUSIONS
Laparoscopic repair is recommended for reoperation of a recurrence after primary open Lichtenstein repair.
Bisgaard
Thue
T
The Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark. thuebisgaard@tdcadsl.dk
Bay-Nielsen
Morten
M
Kehlet
Henrik
H
D019992:Databases as Topic; D005500:Follow-Up Studies; D006550:Hernia, Femoral / Q000601:surgery; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000379:methods*