A single-centre experience of relaparoscopy in complications of laparoscopic inguinal hernia repair-feasibility and outcomes

Abstract

Management of complications of laparoscopic inguinal hernia repair remains challenging as well as debatable. Relaparoscopy in management of these complications is relatively newer concept. We tried to analyse the feasibility of relaparoscopy (transabdominal preperitoneal approach) in management of complications of laparoscopic inguinal hernia repair. The study group included 61 patients (referral cases) from a prospectively maintained database of previous laparoscopic inguinal hernia surgery with majority of the patients of recurrence (n=39). Other complications were mesh infections (n=15), pubic osteitis (n=3), migration of mesh into adjacent viscera (n=3) and meralgia paresthetica (n=1). All patients underwent transabdominal preperitoneal approach (TAPP) between January 2007 and December 2013. Most of the patients had previous TEP repair (n=49) with variable complications detected in the range of 9days to 38months. Small-sized mesh (n=12) and rolled up mesh (n=10) were the causes of recurrence in 57% cases. Mycobacterium tuberculosis (40%) and mixed bacterial infections (33%) strains were detected in the infected mesh. Pubic osteitis and meralgia paresthetica were tackers induced. All patients dealt with TAPP approach. Recurrent hernia cases underwent mesh placement and infected mesh was removed in mesh infection. Tackers were removed in cases of osteitis pubis and meralgia paraesthesia. Median operative time was 62min (42-126min) and hospital stay 3days (2-13days). The relaparoscopy was accomplished in 95.1% of cases with no major intraoperative complications and minimal postoperative morbidity. Relaparoscopy through TAPP approach remains safe and feasible option to deal with primary laparoscopic hernia repair complications. Surgical techniques during primary laparoscopic repair are important cause for aforementioned complications. Though, surgical expertize remains warranted for relaparoscopy.