Pseudo-recurrence following laparoscopic ventral and incisional hernia repair.
OBJECTIVE
Laparoscopic mesh repair is an established alternative to the open repair of herniae of the antero-lateral abdominal wall. However, a definition in the literature of "recurrence" is lacking. This study reviews the phenomenon of pseudo-recurrence in patients who describe recurrent symptoms despite an apparently successful laparoscopic ventral or incisional hernia repair (LVIHR).


METHODS
Cases of LVIHR from 1st January 2004 to 31st December 2007 were identified from the Lothian Surgical Audit database. Patients were contacted by telephone after a minimum of 11 months following operation. Pseudo-recurrences were identified by history and clinical examination, together with radiological investigation if the diagnosis remained in doubt.


RESULTS
One hundred and forty-three repairs were performed in the study period. One hundred and twenty-one patients were contacted (63 incisional and 58 other ventral herniae). Twenty possible recurrences were reported (16.5%). Four were true recurrences and two more were new incisional herniae. There were 14 pseudo-recurrences, arising after 12 incisional and two other ventral hernia repairs. These were due to mesh bulge (10), seroma (3) and retained hernia contents (1).


CONCLUSIONS
True recurrences after LVIHR do occur but should be preventable with good surgical technique. Pseudo-recurrences are more common and may mimic true recurrence. We recommend computed tomography (CT) to clarify the diagnosis and determine the indication for revisional surgery.
Tse
G H
GH
The Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, Scotland, UK. georgetse@doctors.org.uk
Stutchfield
B M
BM
Duckworth
A D
AD
de Beaux
A C
AC
Tulloh
B
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006555:Hernia, Ventral / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000009:adverse effects*; D012008:Recurrence; D013526:Surgical Mesh; D014057:Tomography, X-Ray Computed; D055815:Young Adult