title: Single-port onlay mesh repair of recurrent inguinal hernias after failed anterior and laparoscopic repairs.
abstract: OBJECTIVE
  Despite the exponential increase in the use of laparoscopic inguinal herniorrhaphy, overall recurrence rates have remained unchanged. Therefore, a growing number of patients are presenting with recurrent hernias after conventional anterior and laparoscopic repairs have failed. This study reports our experience with single-incision laparoscopic (SIL) intraperitoneal onlay mesh (IPOM) repair of these hernias.
  
  
  METHODS
  Patients referred with two or more recurrences of inguinal hernia underwent SIL-IPOM from November 1, 2009, to June 24, 2014. A 2.5-cm infraumbilical incision was made, and an SIL port was placed intraperitoneally. Modified dissection techniques were used: chopstick and inline dissection, 5.5-mm/52-cm/30° angled laparoscope, and conventional straight dissecting instruments. The peritoneum was incised above the pubic symphysis, and dissection was continued laterally and proximally, raising the inferior flap below the previous extraperitoneal mesh while reducing any direct, indirect, femoral, or cord lipoma before placement of antiadhesive mesh, which was fixed to the pubic ramus, as well as superiorly, with nonabsorbable tacks before the inferior border was fixed with fibrin sealant. The inferior peritoneal flap was then tacked back onto the mesh.
  
  
  RESULTS
  Nine male patients underwent SIL-IPOM. Their mean age was 53 years and mean body mass index was 26.8 kg/m(2). Mean mesh size was 275 cm(2). Mean operation time was 125 minutes, with a hospital stay of 1 day. The umbilical scar length was 23 mm at the 6-week follow-up. There were no intra-/postoperative complications, port-site hernias, chronic groin pain, or recurrence of the hernia during a mean follow-up of 24 months.
  
  
  CONCLUSIONS
  Inguinal hernias recurring after two or more failed conventional anterior and laparoscopic repairs can be safely and efficiently treated with SIL-IPOM.
authors.affiliation: Discipline of Surgery, Sydney Medical School, University of Sydney at Westmead Hospital, Westmead, NSW, Australia.
authors.forename: Hanh
authors.initials: H
authors.lastname: Tran
authors.affiliation: Sydney Hernia Specialists Clinic, Sydney, NSW, Australia.
authors.forename: Kim
authors.initials: K
authors.lastname: Tran
authors.affiliation: Sydney Hernia Specialists Clinic, Sydney, NSW, Australia.
authors.forename: Marta
authors.initials: M
authors.lastname: Zajkowska
authors.affiliation: Discipline of Surgery, Sydney Medical School, University of Sydney at Westmead Hospital, Westmead, NSW, Australia.
authors.forename: Vincent
authors.initials: V
authors.lastname: Lam
authors.affiliation: Discipline of Surgery, Sydney Medical School, University of Sydney at Westmead Hospital, Westmead, NSW, Australia.
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Hawthorne
mesh_terms: D000328:Adult; D000368:Aged; D015718:Fibrin Tissue Adhesive; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D013526:Surgical Mesh; D055815:Young Adult
chemical_list: D015718:Fibrin Tissue Adhesive
keywords: Intraperitoneal onlay mesh repair; Recurrent inguinal hernia; Single-incision laparoscopic repair
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