Management of recurrent inguinal hernias after total extraperitoneal (TEP) herniorrhaphies.
BACKGROUND
The laparoscopic repair offers clear advantages in recurrent inguinal hernias after open herniorrhaphy. Less clear is the role of laparoscopy for recurrences after previous laparoscopic inguinal herniorrhaphies. In this paper, we present our experience with both laparoscopic and open inguinal hernia repair of laparoscopic recurrences.


METHODS
All patients who had undergone repair of recurrences after previous laparoscopic hernia repair from July 2004 to July 2007 were included in this study. Charts were reviewed for all these patients.


RESULTS
Six patients were diagnosed with 7 recurrent inguinal hernias after laparoscopic repairs. All the initial laparoscopic repairs, except for one, were total preperitoneal (TEP) with the placement of lightweight polypropylene mesh. The average time from the initial repair to the diagnosis of recurrence was 20 months (range 3-84). Four of the 7 recurrences were treated with a laparoscopic approach. The other three recurrences were repaired in an open fashion as per the preoperative plan. In 2 of the laparoscopic cases, the peritoneal flap was not able to cover the mesh, so a tissue-separating mesh with fibrin sealant was utilized to cover the myopectineal orifice. No intra- or postoperative complications were recorded. There were no recurrences at an average follow-up of 14 months (range, 11-17).


CONCLUSIONS
Laparoscopic repair can be offered to those patients with a recurrence after a previous laparoscopic repair. Further studies comparing laparoscopic repair versus open repair of recurrences after laparoscopic inguinal hernia repair will be helpful in defining the best approach when encountering these recurrences.
Lo Menzo
Emanuele
E
Miami VA Healthcare System, University of Miami, Miller School of Medicine, 1201 NW 16th Street, Miami, FL 33125, USA. elomenzo@hotmail.com
Spector
Seth A
SA
Iglesias
Alberto
A
Martinez
Jose M
JM
Huaco
Jorge
J
DeGennaro
Vincent
V
Madan
Atul K
AK
D000368:Aged; D015331:Cohort Studies; D006552:Hernia, Inguinal / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps; D013526:Surgical Mesh; D013536:Suture Techniques; D016896:Treatment Outcome