Laparoscopic Totally Extraperitoneal Herniorrhaphy: Is it Feasible for Recurrent Inguinal Hernias?

Kim, Zisun; Cho, Sung Woo; Kim, Yong Jin; Choi, Dongho; Kang, Gil Ho; Song, Dan; Kim, Jae Joon; Hur, Kyung Yul

Abstract

PURPOSE
Laparoscopic totally extraperitoneal (TEP) herniorrhaphy is an effective surgical technique for recurrent inguinal hernia. The recent introduction of various types of prosthetic mesh and the technical improvements in laparoscopic herniorrhaphy have allowed this modality to be used for various types of recurrent inguinal hernias, although careful selection of surgical techniques is required according to the patient's condition and the type of previous surgery.
METHODS
One thousand and thirty cases were scheduled to undergo laparoscopic TEP herniorrhaphies from December of 2000 to August of 2008. We retrospectively collected and analyzed the data on the patient characteristics, the types of hernia, the number of previous recurrences, the operating technique, the operating time, the postoperative hospital stay and the postoperative complications.
RESULTS
A total of 86 herniorrhaphies were performed in 83 patients with recurrent inguinal hernias. The mean patient age was 50.4 years. The total number of recurrences among the 83 patients was 118 cases and the number of recurrences was as follows: 1st in 65 patients, 2nd in 12 patients, 3rd in 7 patients and 4th in 2 patients. Eighty one laparoscopic TEP herniorrhaphies were performed, and 5 cases were performed by laparoscopic transabdominal preperitoneal repair or laparoscopic intraperitoneal onlay mesh repair. The mean operative time was 29.9 minutes, and there was no statistical correlation between the type of prior herniorrhaphy and the operative time. The mean postoperative hospital stay was 0.9 days and no major complications occurred.
CONCLUSION
Selecting the type of surgery to perform for treating recurrent inguinal hernia has become complicated due to many recent diversified techniques of herniorrhaphy. Although laparoscopic TEP herniorhaphy is effective for treating recurrent inguinal hernia, a meticulous approach and various surgical techniques are required when prosthetic mesh has been previously placed on the preperitoneal space.