Abstract
Review of literature has revealed no definite cause behind indirect inguinal hernia recurrence following laparoscopic trans-abdominal pre-peritoneal hernioplasty. As a matter of surgeons' preference such cases are preferred to be managed through a different approach; either trans-inguinal pre-peritoneal or even open procedure to reduce the needed dissection effort.
Highlights
Introduction & Review of Research ConceptIn spite that laparoscopic hernioplasty is still not the gold standard for repair, recent worldwide figures state that 1520% of hernias are being done laparoscopically
Exploration of the recurrent hernia has showed a unique observation giving the reason for hernia recurrence; that is neglecting circumferential dissection for the sac neck at the level of the internal ring
Retaining adherent neck of sac to the medial side of the spermatic cord; Old mesh is displaced beyond the course of the hernia sac Retained adhesion between medial aspect sperm. cord & hernia sac neck
Summary
In spite that laparoscopic hernioplasty is still not the gold standard for repair, recent worldwide figures state that 1520% of hernias are being done laparoscopically. Laparoscopic hernioplasties reduced the recurrence rates to less than 0.5% in most series. The main two issues for the hernioplasty technique are dissection and separation of the hernia sac from the contents of the spermatic cord and positioning a mesh over the myo-pectineal ring. Theoretically the reason of recurrence should be related to either one or both of these two issues
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