Selection of surgical methods for recurrent inguinal hernia and corresponding clinical efficacy

Abstract

Objective To investigate the choice of surgical methods for recurrent inguinal hernia and their corresponding clinical efficacy. Methods The retrospective cross-sectional study was conducted. The clinical data of 98 patients with recurrent inguinal hernia who were admitted to the First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) between January 2015 and December 2017 were collected. There were 90 males and 8 females, aged (62±16)years, with a range from 18 to 84 years. According to the previous surgical approaches of patients and the interference degree to the preperitoneal space, size of the defects, type of recurrent inguinal hernia, and the surgeon′s mastery of laparoscopic hernia repair technology, corresponding surgical methods for recurrent inguinal hernia were selected. Observation indicators: (1) conditions of recurrent inguinal hernia; (2) conditions of reoperation; (3) follow-up. Follow-up using outpatient examiantion, telephone interview, and website APP was performed to detect the conditions of recurrent hernia and complications at 3-7 days, 1 month, 3 months, 6 months, and 12 months after operation up to December 2018. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were represented as M (range). Count data were expressed as absolute numbers. Results (1) Conditions of recurrence inguinal hernia: the time to recurrence of inguinal hernia in 98 patients was 1.5 years (0.5 years, 4.0 years), ranging from 1 day to 40.0 years after operation. Five patients had recurrence more than 3 times. There were 47 cases classified as type R1, 21 cases as type R2, and 30 cases as type R3 according to Campanelli classification of recurrent hernias. Seventy-five of 98 patients were treated by anterior approach, including 26 undergoing Bassini repair, 16 undergoing Lichenstein repair, 11 undergoing Shouldice repair, 9 undergoing McVay repair, 5 undergoing Rutkow repair, 4 undergoing simple high ligation, and 4 undergoing Millikan repair. The time to postoperative recurrence was 3.0 years (0.7 year, 10.0 years). Twenty-three patients had been treated by posterior approach, including 2 undergoing reinforced preperitoneal Kugel repair combined with anterior approach, 1 undergoing Gilbert repair, and 1 undergoing Stoppa repair, with the time to postoperative recurrence of (3.2±1.6)years, 11 undergoing laparoscopic totally extraperitoneal prosthesis (TEP) and 8 undergoing laparoscopic transabdominal preperitoneal hernia repair (TAPP), with the time to postoperative recurrence of (1.5±0.9)years. (2) Conditions of reoperation: of the 75 patients firstly being treated by anterior approach, 62 underwent TAPP for reoperation, 9 underwent Kugel repair, and 4 underwent TEP, and the operation time was (66±25)minutes, (61±19)minutes, (70±26)minutes, respectively. Local anesthesia was used in 1 case with Kugel operation and general anesthesia was used in 74 cases. Of the 23 patients firstly being treated with posterior approach herniorrhaphy, 13 with hernia ring diameter<2 cm were treated with Lichtenstein repair and 10 with hernia ring diameter ≥2 cm were treated with modified mesh patch repair for reoperation. The operation time was (53±14)minutes and (58±14)minutes, respectively. There was 1 case of epidural anesthesia (Lichtenstein repair), 2 cases of local anesthesia (1 case of Lichtenstein repair and 1 case of modified mesh repair), and 20 cases of general anesthesia. (3) Follow-up: all the 98 patients were followed up for 1-48 months, with a median follow-up time of 18 months. There was no recurrent hernia during the follow-up. During the follow-up, 31 patients had early postoperative pain, including 11 with TAPP, 1 with TEP, 5 with Kugel repair, 7 with Lichtenstein repair, 7 with modified mesh patch repair, and 5 patients had chronic pain, including 1 with TAPP, 1 with Kugel repair, 1 with Lichtenstein repair, 2 with modified mesh repair, 2 patients had hematoma, including 1 with TAPP, 1 with Lichtenstein repair, 3 with TAPP had effusion. Thirty-six patients with complications were improved after follow-up and symptomatic and supportive treatment. Conclusion The reasonable decision on surgical methods for recurrent inguinal hernia depends on whether the previous operation interferes with the preperitoneal space, defect size and classification, and surgeon′s skill of laparoscopic hernia repair, which can achieve good efficacy. Key words: Hernia; Inguinal hernia, adult; Recurrence; Laparoscopy; Choice of treatment