Repair Of Recurrent Inguinal Hernia Research Articles

LAPARASCOPIC VERSUS OPEN MESH REPAIR FOR RECURRENT INGUINAL HERNIA: A SYSTEMATIC REVIEW

Background: Inguinal hernia is one of the most common conditions seen in clinic, and is often treated through the general surgery department. Laparoscopic repair and open repair with mesh are the typical treatments for inguinal hernia, and both regimens have proved beneficial in treating inguinal hernia. However, recurrence, with a rate as high as 33, poses a significant problem to the effective treatment of inguinal hernia. The aim: This study aims to show about laparascopic versus open mesh repair for recurrent inguinal hernia. Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. So, the experts were able to make sure that the study was as up-to-date as it was possible to be. For this search approach, publications that came out between 2013 and 2023 were taken into account. Several different online reference sources, like Pubmed and SagePub, were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: In the PubMed database, the results of our search brought up 10 articles, whereas the results of our search on SagePub brought up 60 articles. The results of the search conducted for the last year of 2013 yielded a total 2 articles for PubMed and 14 articles for SagePub. The result from title screening, a total 1 articles for PubMed and 10 articles for SagePub. In the end, we compiled a total of 7 papers. We included five research that met the criteria. Conclusion: The laparoscopic approach is superior to the open mesh approach for the repair of recurrent inguinal hernia in some aspects, including the incision infection rate and length of hospital stay. However, more high-quality studies on the effects of laparoscopic and open mesh repair for the treatment of recurrent inguinal hernia are warranted.

A Randomized Trial Investigating the Laparoscopic Transabdominal Preperitoneal Approach for Recurrent Inguinal Hernia Repair

Background: Repairing a recurrent hernia is a challenging endeavor due to the pre-existing weakened tissues and altered anatomy. Among the available approaches, the open posterior preperitoneal approach has demonstrated significantly better outcomes compared to the anterior approach. Additionally, the laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair represents an evolving technique with the advantages of minimally invasive surgery. The objective of our study is to perform a comparative analysis of these three approaches for the repair of recurrent inguinal hernias, focusing on complications and the occurrence of early recurrences. This research aims to provide valuable insights into the most effective and safe approach for managing this challenging surgical condition. Methods: In our study, we conducted a randomized allocation of 200 patients into three equal groups: Group A, Group B, and Group C. Patients in Group A underwent the open posterior preperitoneal approach, while those in Group B received transinguinal anterior tension-free repair. Group C patients underwent the laparoscopic transabdominal preperitoneal (TAPP) procedure. The primary endpoint of our study was to assess the recurrence of inguinal hernias following the respective surgical approaches. Results: Our study yielded several noteworthy findings. The mean hospital stay, time to return to work, and time off from work were all shorter in Group C when compared to Groups A and B. Chronic postoperative pain was observed in 13.33% of patients in Group A, 30% of patients in Group B, and 10% of patients in Group C. Notably, the overall complication rate was lower in both Groups A and C at 19.7%, while Group B had a higher complication rate of 34.36%. Conclusion: In the context of recurrent inguinal hernia repair, our study findings suggest that the laparoscopic and open posterior approaches are equally effective in terms of operative outcomes. The open preperitoneal hernia repair stands out as a cost-effective option with a low recurrence rate. Patients undergoing this procedure experience a relatively short postoperative recovery period and report minimal postoperative pain. This approach has demonstrated significantly better outcomes compared to the commonly used anterior approach.

Feasibility and safety of redo laparoscopic repair of recurrent inguinal hernia following previous endolaparoscopic repair.

Laparoscopic redo inguinal hernia (LRIH) repairs are fraught with challenges as the pre-peritoneal space is violated due to previous surgery and the presence of mesh. The purpose of this study was to present the feasibility and safety of LRIH in a series of patients with recurrent inguinal hernia following previous endolaparoscopic repair and present technical experiences and clinical outcomes in this subset of patients. This was a retrospective study from a prospective database of 16 patients who underwent LRIH between March 2014 and December 2020. The decision to do a redo laparoscopic surgery was undertaken after a detailed discussion with the patient. The operative details, challenges faced and tips to overcome difficulties have been explained in detail. Out of 16 patients (mean age 49.5 years, all men), 15 underwent laparoscopic redo trans-abdominal pre-peritoneal (TAPP) mesh repair and 1 underwent laparoscopic enhanced-view totally extra-peritoneal (eTEP) mesh repair. The mean operating time was 68.5 min for unilateral, 115 min for bilateral TAPP and 90 min for eTEP. The main contributing factors for recurrences were mesh migration, insufficient size of the mesh and inadequate fixation. There was no conversion to open repair. The duration of stay was 1-2 days. There was no documented re-recurrence during the follow-up period of 2-9 years. Based on our experience, redo laparoscopic inguinal hernia mesh repair after previous endolaparoscopic repair is feasible, effective and safe in experienced hands.

635 Giant Paratesticular Liposarcoma Imitating a Recurrent Right Inguinoscrotal Hernia

Abstract Case 48-year-old male presented for elective open recurrent right inguinal hernia (RIH) repair due to ongoing right inguinoscrotal swelling; and an ultrasound suggestive of a large indirect inguinal hernia containing peritoneal fat and extending into the scrotum with displacement of the right testis. Previous open RIH repair with mesh completed 12mths prior found a moderate direct inguinal hernia; and during a post-op phone review (given the COVID pandemic) noted he was healing well. No urinary/obstructive or systemic symptoms identified. Other history included alpha thalassemia trait, ex-smoker and non-English speaking background (NESB). Intraoperatively there was no evidence of recurrent hernia, and the mesh was intact; however a large right scrotal mass was identified as the cause. An 18x8cm soft lipomatous mass surrounded the right testicle and extended up towards the cord structures at the superficial inguinal ring. Given the concern for malignancy, a right orchidectomy and excision of scrotal mass was performed. Histology confirmed a well differentiated grade 1 liposarcoma. He recovered well and is undergoing close MRI surveillance - with no sign of recurrence. Discussion Liposarcoma is an important differential for scrotal masses and can imitate an inguinoscrotal hernia on ultrasound, MRI is the gold standard investigation. The above case highlights the importance of physical post-operative examination and barriers to care during the COVID pandemic, particularly in those with NESB. Informed consent was imperative, we could safely proceed with the appropriate surgery as the patient had been explicitly consented for testicular loss due to recurrent nature of the operation.

Elective Recurrent Inguinal Hernia Repair: Value of an Abdominal Wall Surgery Unit

BackgroundThe aim of this study was to analyze the impact of an abdominal wall surgery unit on postoperative complications (within 90 days postoperatively), hernia recurrence and chronic postoperative inguinal pain after elective recurrent inguinal hernia repair.MethodsWe conducted a retrospective cohort study of all adult patients who underwent elective recurrent inguinal hernia repair between January 2010 and October 2021. Short- and long-term outcomes were compared between the group of patients operated on in the abdominal wall surgery unit and the group of patients operated on by other units not specialized in abdominal wall surgery. A logistic regression model was performed for hernia recurrence.ResultsA total of 250 patients underwent elective surgery for recurrent inguinal hernia during the study period. The patients in the abdominal wall surgery group were younger (P ≤ 0.001) and had fewer comorbidities (P ≤ 0.001). There were no differences between the groups in terms of complications. The patients in the abdominal wall surgery group presented fewer recurrences (15% vs. 3%; P = 0.001). Surgery performed by the abdominal wall surgery unit was related to fewer recurrences in the multivariate analysis (HR = 0.123; 95% CI = 0.21–0.725; P = 0.021).ConclusionsSpecialization in abdominal wall surgery seems to have a positive impact in terms of recurrence in recurrent inguinal hernia repair. The influence of comorbidities or type of surgery (i.e., outpatient surgery) require further study.

OC-066 TEMPORAL PATTERN FOR REOPERATION OF INGUINAL HERNIA RECURRENCE AFTER A PRIMARY SHOULDICE REPAIR

Abstract Aim To identify timing patterns associated with reoperation for recurrence of inguinal hernia in patients undergoing Shouldice repair (RIHaSR) for primary inguinal hernias. Material and methods Patients undergoing a recurrent inguinal hernia repair from 2013–2017 were initially identified. Subgroup analysis of the first recurrence after a Shouldice repair at this institution were selected. Data collection of this subgroup of patients and data analysis were performed. Results From the 138 patients undergoing a re-operation for a first time inguinal hernia recurrence after a Shouldice repair, 125 patients were included in the analysis. The mean age was 50.8±13.9, BMI 24.6+2.6 and 97% were male. Regarding time to surgery for recurrence, the most common interval was in the first 5 years after surgery (37.6% of patients; mode: 1 year; median: 7 years; mean: 13.7±13.8 years). A bimodal pattern of temporal recurrence was noted according to patient age: patients >50 had a peak of reoperation for recurrence in the first 5 years (68% of reoperations for recurrence) with a decrescendo pattern, meanwhile patients <50 demonstrated a stable incidence of reoperation for recurrence in the initial 25 years of follow-up. Conclusions Patients undergoing surgery for RIHaSR presented a bimodal temporal pattern according to age at the time of primary surgery. Patients older than 50y.o. presenting a peak of RIHaSR in the first 5 years after primary surgery in comparison to younger patients that present a relatively stable frequency of reoperation for recurrence up to a 25-year follow-up.

OC-018 Elective recurrent inguinal hernia repair. Value of an Abdominal Wall Surgery Unit

Abstract Purpose The aim of this study is to analyze the influence of an abdominal wall surgery unit in postoperative complications (within postoperative 90 days), hernia recurrence and chronic postoperative inguinal pain after elective recurrent inguinal hernia repair. Methods This retrospective cohort study included patients who underwent elective recurrent inguinal hernia repair between January 2010 and October 2021. The short- and long-term outcomes between the groups of patients operated on by the Abdominal Wall Surgery Unit and groups operated on by surgeons outside of the specialized abdominal wall group were compared. A logistic regression model was performed for hernia recurrence. Results A total of 250 patients underwent elective surgery for recurrent inguinal hernia during the study period. Patients in the abdominal wall surgery group were younger (P= <0.001) and had less comorbidities (P= <0.001). Complications were similar in both groups. Patients in the abdominal wall surgery group presented fewer recurrences (15% vs 3%; P= 0.001). In the multivariate analysis, surgery performed by the abdominal wall surgery unit was related to fewer recurrences (HR= 0.164; 95% CI= 0.44–0.613; P=0.007). Conclusions Recurrent inguinal hernia repair is associated with better results in terms of recurrence when it is performed by a specialized abdominal wall unit.

Comparative Analysis of Laparoscopic vs Open Inguinal Hernia Approach for Repair of Recurrent Bilateral Inguinal Hernia

Comparative Analysis of Laparoscopic vs Open Inguinal Hernia Approach for Repair of Recurrent Bilateral Inguinal Hernia

Surgical aspects and early morbidity of patients undergoing open recurrent inguinal hernia repair.

This study aims to characterize the patterns of recurrence associated with specific types of primary inguinal hernia repair techniques used for and their respective correlations with early morbidity, in patients undergoing open repair for their first hernia recurrence. After ethics approval was obtained, a retrospective review of charts from patients who underwent open surgery for repair of a first recurrence after a previous inguinal hernia repair during 2013-2017 was completed. Statistical analyses were performed and p-values < .05 are reported as statistically significant. 1393 patients underwent 1453 surgeries for recurrent inguinal hernias at this institution. Operations for recurrence were longer (61.9 ± 21.1 vs. 49.3 ± 11.9; p < .001), required more frequent intra-operative surgical consultation (1% vs. 0.2%; p < .001) and had a higher incidence of surgical-site infections (0.8% vs. 0.4%; p = .03) than primary inguinal hernia repairs. When comparing the patterns of recurrence among different techniques of primary repairs, patients undergoing laparoscopic hernia repair presented with a higher incidence of indirect recurrences. Reoperations after a Shouldice repair and open mesh repair represented markers for higher surgical difficulty in the recurrent operation (longer operative time, higher identification of heavy scarring, less nerve identification, and higher frequency of intra-operative consultation), but not higher rates of complications when compared with other techniques. Open reoperations for inguinal hernia first recurrences are more complex, with noticeable differences according to the index operation, and associated with higher morbidity when compared with primary hernia repairs. This complexity varies according to the type of primary surgery, with a previous Shouldice repair and open hernia repair with mesh presenting higher surgical difficulties although this did not translate to higher incidence of early complications. This information may allow adequate allocation of surgeons with an expertise in recurrent hernias and choice of recurrent repair method (laparoscopic or open) based on the primary surgery.

Clinical comparison of modified TEP technique with open preperitoneal approach and transabdominal preperitoneal repair for recurrent inguinal hernia.

Clinical comparison of modified TEP technique with open preperitoneal approach and transabdominal preperitoneal repair for recurrent inguinal hernia.

Surgical repair of recurrent inguinal hernia by using Dacron mesh

Surgical repair of recurrent inguinal hernia by using Dacron mesh

Laparoscopic recurrent inguinal hernia repair in children who underwent open procedure

Laparoscopic recurrent inguinal hernia repair in children who underwent open procedure

Lichtenstein Repair in Inguinal Hernia- A Retrospective Study on the Impact of In-Hospital Costs of Diabetes Mellitus.

Inguinal hernia is one of the most common conditions in surgical departments and diabetes is known to have a significant impact on both patients' health and healthcare system. The current study aims to evaluate extensively the differences in costs for different subgroups of diabetic patients undergoing inguinal hernia repair in a tertiary care medical center in South-West Romania. A total number of 195 patients underwent hernia repair for primary or recurrent inguinal hernia between 2015 and 2020 and were included in the analysis. The group was divided into diabetic/non-diabetic patients and each of these subgroups was studied separately according to the presence or absence of comorbidities, sex and place of origin. Statistically significant differences were found in the division of the age group, highlighting the fact that in diabetic patients the average age was around 74.76 years, unlike those without diabetes in which the average age was approximately 61.31 years. Another statistically significant difference was observed in the classification by hospitalization days of the group of patients with incarcerated inguinal hernia, in a sense that diabetic patients required a prolonged hospitalization by 1.5 days as opposed to non-diabetics. The costs of hospitalization for diabetic patients undergoing hernia repair surgery were marginally higher than in non-diabetic patients, but no statistical difference could be observed between any of the costs subsets in the two patients groups.

P-155 ROLE OF MDT IN CPIP MANAGEMENT: LITERATURE REVIEW

Abstract Abstract Chronic Post-operative Inguinal Pain (CPIP), is recognised as a long term condition and has a significant effect on patients’ quality of life. CPIP affects 18–30% of patients after an open inguinal hernia repair and 6% of patients after a laparoscopic inguinal hernia repair. CPIP result from several causes such as a pre-operative nerve lesion in other area of the body, an intra-operative nerve injury, or due to the intensity of acute post-operative inflammation and healing. a multidisciplinary clinic would be considered the best approach in order to assess patients’ pain and identify an individual management plan. This review allowed the team to choose which literature could be used to support the implementation of the clinical practice change. Method Literature searches were performed using PubMed and Embase databases were searched using key terms to include all related articles in the last ten years. three independent reviewers to choose included and excluded articles with two steps. Results Out of 25 articles found by the research, 8 articles included in this review including MDT about CPIP, meeting including criteria after the full articles reviewed. it was important to understand the nature and mechanisms of Chronic Post-operative inguinal hernia. several risk factors have been identified, which may be causing CPIP such as young age, recurrent inguinal hernia repair procedure and presence of pain before the procedure. Because of the complexity of CPIP, many authors concluding that a multidisciplinary approach should be considered the more appropriate method to ensure an effective and safe treatment. This include the need of regular follow up after an inguinal hernia repair to identify the chronic pain and establish an appropriate management plan. Conclusions Although the literature review enabled the team to gather useful information about the topic of the clinical practice change; it was evident that more researches and studies need to be completed in order to identify the safest and effective treatment for patients presenting with CPIP.

Laparoscopic TEP Inguinal Hernia Repair for Recurrent Inguinal Hernia in an Adult with History of Herniotomy Done for Congenital Inguinal Hernia in Childhood - A Rare Case Report

Laparoscopic TEP Inguinal Hernia Repair for Recurrent Inguinal Hernia in an Adult with History of Herniotomy Done for Congenital Inguinal Hernia in Childhood - A Rare Case Report

P004 TREATMENT OF RECURRENT INGUINAL HERNIA AFTER TRANSINGUINAL PREPERITONEAL (TIPP) SURGERY

Abstract Aim To report feasibility and surgical outcomes of recurrent inguinal hernia repair after TransInguinal PrePeritoneal (TIPP) repair. Material and Methods Patients who underwent recurrent IHR after TIPP between January 2013 and January 2015 in a single hernia-dedicated teaching hospital were included. Exclusion criteria were femoral hernia, incarcerated hernia and reasons for unreliable follow-up. Electronic medical records were assessed retrospectively to register surgical outcomes and complications. Results Thirty-three patients underwent surgical repair of recurrent inguinal hernia after TIPP. Twenty patients were treated with a “re-TIPP when possible” strategy; resulting in 13 successful re-tipps and 7 conversions to Lichtenstein repair. Eleven patients underwent primarily a Lichtenstein’s repair, the remaining two patients underwent recurrent IHR using other techniques (transrectus sheath Pre-Peritoneal and transabdominal preperitoneal repair). Mean time of surgery was 44.7 minutes (standard deviation 16.7). There was one patient (3.0%) with a re-recurrent inguinal hernia during follow-up. Other minor complications included urinary tract infection. There were no significant differences in post-operative results between the different surgical techniques used for recurrent IHR. Conclusions These results indicate that after TIPP it is feasible and safe to perform re-surgery for recurrence with an anterior approach again. For these recurrences, a Lichtenstein can be performed, or a ‘re-TIPP if possible’ strategy can be applied by experienced TIPP surgeons. Whether a re-TIPP has the same advantages over Lichtenstein as is for primary inguinal hernia surgery, needs to be evaluated in a prospective manner.

Treatment of recurrent inguinal hernia after TransInguinal PrePeritoneal (TIPP) surgery: feasibility and outcomes in a case series.

TransInguinal PrePeritoneal (TIPP) inguinal hernia repair (IHR) combines an open anterior approach with a preperitoneal position of the mesh. Advantages include reduced chronic postoperative inguinal pain, low recurrence rates and quick recovery. Critics have expressed concerns that recurrent IHR after TIPP could be difficult and with an increased risk of complications due to the formation of scar tissue in both the anterior and posterior anatomical inguinal planes. This study reports feasibility and outcomes of recurrent IHR after TIPP repair. Patients who underwent recurrent IHR after TIPP between January 2013 and January 2015 in a single hernia-dedicated teaching hospital were included. Exclusion criteria were femoral hernia, incarcerated hernia and reasons for unreliable follow-up. Electronic medical records were assessed retrospectively to register surgical outcomes and complications. Thirty-three patients underwent surgical repair of recurrent inguinal hernia after TIPP. Twenty patients were treated with a "re-TIPP when possible" strategy; resulting in 13 successful re-TIPPs and 7 conversions to Lichtenstein repair. Eleven patients underwent a primary Lichtenstein's repair, the remaining two patients underwent recurrent IHR using other techniques (TransREctus sheath PrePeritoneal and TransAbdominal PrePeritoneal repair). Mean time of surgery was 44.7min (standard deviation 16.7). There was one patient (3.0%) with a re-recurrent inguinal hernia during follow-up. Other minor complications included urinary tract infection. These results indicate that after TIPP it is feasible and safe to perform re-surgery for recurrent inguinal hernia with an anterior approach again. For these recurrences, a Lichtenstein repair can be performed, or a "re-TIPP if possible"strategy can be applied by experienced TIPP surgeons, tailored to the intraoperative findings. Whether a re-TIPP has advantages over Lichtenstein should be evaluated in a prospective manner.

Comparative Study between Laparoscopic versus Open Hernioplasty in Repair of Unilateral Non Recurrent Inguinal Hernia

Abstract Background Laparoscopic surgery has led to many changes in the management of surgical patients and significantly reduced the incidence of complications associated with open surgical procedures 1. At present, laparoscopic hernia repair has gained clinical significance in patients with bilateral or recurrent hernia. 2 Objectives The aim of this study is to compare open hernioplasty and laparoscopic hernia repair in unilateral non recurrent inguinal hernia. The present study will be performed on 30 patients to compare the effectiveness of laparoscopic hernia repair and open hernioplasty and to assess the intra operative and post-operative complications, duration of surgery, hospital stay, postoperative morbidity, recurrence and patient satisfaction. Patients and Methods . Comparative studies on 30 patients were classified according the type of operative technique into 2 groups: Group A patients underwent laparoscopic technique (15 patients), group B patients underwent open technique (15 patients) to evaluate and compare the open and laparoscopic techniques in unilateral non recurrent inguinal hernia repair as regard operative time,post operative pain, hospital stay, urine retention, parathesia, numbness, seroma,, wound infection and recurrence Results Our study revealed highly significant increase in operative time in laparoscopic group; compared to open group of patients; with highly significant statistical difference (p value &amp;lt; 0.0001), highly significant decrease in post-operative pain score in laparoscopic group; compared to open group of patients; with highly significant statistical difference. (p value = 0.00434),highly significant decrease in postoperative hospital stay in laparoscopic group; compared to open group of patients; with highly significant statistical difference. (p value = 0.000003), significant decrease in post operative parathesia and numbness in laparoscopic group; compared to open group of patients; (p value =0.000414),highly significant decrease in post-operative urine retention in laparoscopic group; compared to open group of patients; with highly significant statistical difference (p value= 0.000267). Conclusion The laparoscopic technique is superior to the open technique of tensionfree repair, in terms of immediate post-operative complications and delayed pain and paresthesia also in terms of safety.

Outcomes of primary and recurrent inguinal hernia repair with prosthetic mesh in a single region over 15years.

Sutured inguinal hernia repairs are now uncommon, with evidence suggesting that those augmented with mesh are associated with a lower recurrence rate. We aimed to explore the suggestion that the established use of mesh does indeed lower the rate of operation for recurrence in a single National Health Service region. We collected retrospective Office of Population Censuses and Surveys coded data across one region of all primary and recurrent inguinal hernia repairs over 15years (2004-2019). Electronic records of recurrent repairs were scrutinised to identify year and type of previous primary repair. In total, 7,234 repairs were performed during this time, of which 289 (4%) were for symptomatic recurrence. Operations for primary repair increased year on year (111 in 2004 to 402 in 2019). Frequency of operation for recurrent herniation declined with increasing use of mesh (8.8% in 2004 to 3.5% in 2019). The majority of repairs (73%) for recurrence were by an open approach. As opposed to an open mesh repair, a primary laparoscopic repair was associated with an earlier recurrence. Inguinal hernia repairs are increasing in frequency but operations for later symptomatic recurrence following an open primary prosthetic mesh repair are not.

Laparoscopic repair for recurrent inguinal hernia after previous laparoscopic approach

Background and aim Relaparoscopic repair of recurrent inguinal hernia carries a lot of challenges. The encountered complex surgical technique is assumed to have greater possibilities of surgical complications with consequent higher recurrence rates. The aim of this study was to evaluate the feasibility, safety, and reliability of laparoscopic approach for recurrent inguinal hernia after previous laparoscopic repair. Patients and methods Records of 33 patients with 34 recurrent inguinal hernias after previous laparoscopic management have been retrospectively revised. The performed procedure for second repair was transabdominal preperitoneal repair for all the cases. Data of perioperative complications, immediate postoperative course, and hernia recurrence were collected and analyzed. Results No intraoperative complications were encountered. Postoperative pain was recorded as moderate. The mean follow-up period ranged from 14 to 40 months with a mean of 24.82±6.9. During the follow-up period, three (9%) cases developed groin seroma and one (3%) case had transient thigh numbness. Of the patients, 85% returned to normal daily activities within 14 days postoperatively. Two patients had rerecurrence of the hernia and they were managed by Lichtenstein repair. Conclusion Relaparoscopic repair of recurrent inguinal hernia is safe and applicable. The procedure should be performed with experienced hands.