Single-incision laparoscopic intraperitoneal onlay mesh repair for the treatment of multiple recurrent inguinal hernias.
BACKGROUND
Despite an exponential rise in laparoscopic surgery for inguinal herniorrhaphy, overall recurrence rates have remained unchanged. Therefore, an increasing number of patients present with recurrent hernias after having failed anterior and laparoscopic repairs. This study reports our experience with single-incision laparoscopic (SIL) intraperitoneal onlay mesh (IPOM) repair for these hernias.


METHODS
All patients referred with multiply recurrent inguinal hernias underwent SIL-IPOM from November 1 2009 to October 30 2013. A 2.5-cm infraumbilical incision was made and a SIL surgical port was placed intraperitoneally. Modified dissection techniques, namely, "chopsticks" and "inline" dissection, 5.5 mm/52 cm/30° angled laparoscope and conventional straight dissecting instruments were used. The peritoneum was incised above the symphysis pubis and dissection continued laterally and proximally raising an inferior flap, below a previous extraperitoneal mesh, while reducing any direct/indirect/femoral/cord lipoma before placement of antiadhesive mesh that was fixed into the pubic ramus as well as superiorly with nonabsorbable tacks before fixing its inferior border with fibrin sealant. The inferior peritoneal flap was then tacked back onto the mesh.


RESULTS
There were 9 male patients who underwent SIL-IPOM. Mean age was 55 years old and mean body mass index was 26.8 kg/m2. Mean mesh size was 275 cm2. Mean operation time was 125 minutes with hospital stay of 1 day and umbilical scar length of 21 mm at 4 weeks' follow-up. There were no intraoperative/postoperative complications, port-site hernias, chronic groin pain, or recurrence with mean follow-up of 20 months.


CONCLUSIONS
Multiply recurrent inguinal hernias after failed conventional anterior and laparoscopic repairs can be treated safely and efficiently with SIL-IPOM.
Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
Hanh Minh
HM
Tran
The Sydney Hernia Specialists Clinic, Sydney, New South Wales, Australia.
Kim
K
Tran
The Sydney Hernia Specialists Clinic, Sydney, New South Wales, Australia.
Marta
M
Zajkowska
Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
Vincent
V
Lam
Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
Wayne
W
Hawthorne
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010537:Peritoneum / Q000601:surgery*; D011184:Postoperative Period; D012008:Recurrence; D013526:Surgical Mesh
Intraperitoneal onlay mesh repair; Multiply recurrent inguinal hernia; Single-incision laparoscopic surgery