title: An additional strip of mesh minimizes hernia recurrence after laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. An analysis of 490 cases over 10 years.
abstract: OBJECTIVE
  The laparoscopic inguinal hernia repair has gained significant interest over the years as an alternative to the conventional open technique as a result of its faster recovery time, reduced postoperative pain and numbness. However the recurrence rates are in the order of 2.3% compared to the 1.3% quoted for the equivalent open approach. Much of these recurrences occur either caudal to the fold created in the mesh once in-situ or lateral to the border of the mesh. This technique aims to address both these areas of concern using an additional strip of mesh across the centre to brace the mesh and create a bolster to maintain mesh stability.
  
  
  METHODS
  The technique involves cutting a 2 cm strip from the 15x15 cm mesh which is laid length-ways over the remaining 13x15 cm mesh, keeping the longest dimension in the medial to lateral plane, and loosely tacked. The strip over hangs the lateral border of the mesh to control the lateral space. Recurrence rates were evaluated from a prospectively collected data series as well as outcomes collected from a questionnaire over a 10 year period between January 2001 and October 2011. Primary outcomes were confirmed hernia recurrence requiring surgical repair.
  
  
  RESULTS
  Four hundred ninety-one patients underwent laparoscopic totally extraperitoneal (TEP) hernia repair with outcomes including recurrence rates were retrospectively examined through a prospectively collected database. Subsequently 400 patients were sent a validated questionnaire. 246 responded (62% response rate). One recurrence (0.3%), which occurred 4 years after the original laparoscopic repair, was described across the series.
  
  
  CONCLUSIONS
  The use of the additional mesh strip potentially reduces TEP hernia recurrence rates beyond simply the benefits of the learning curve. Although, questionnaires are notoriously inaccurate, the value and consistency between both evaluation techniques suggests that this level of reduction is significant to warrant further prospective trials.
authors.affiliation: Department of Surgery, Epsom and St Helier's University Hospitals NHS trust, Carshalton, UK - d.al-musawi@doctors.org.
authors.forename: J
authors.initials: J
authors.lastname: Clark
authors.forename: R
authors.initials: R
authors.lastname: Wong
authors.forename: A
authors.initials: A
authors.lastname: Richardson
authors.forename: A
authors.initials: A
authors.lastname: Haque
authors.forename: J
authors.initials: J
authors.lastname: Vatish
authors.forename: A
authors.initials: A
authors.lastname: Bello
authors.forename: D
authors.initials: D
authors.lastname: Al-Musawi
mesh_terms: D000465:Algorithms; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000517:prevention & control* / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D016347:Medical Records Systems, Computerized; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh; D011795:Surveys and Questionnaires; D016896:Treatment Outcome