Repair Of Recurrent Inguinal Hernia Research Articles

Laparoscopic repair of recurrent inguinal hernias

Repair of recurrent inguinal hernias is associated with recurrence rates as high as 30% and complication rates higher than for primary hernias. In a prospective study, results were evaluated after laparoscopic transabdominal preperitoneal hernia repair in 192 patients with 200 recurrent inguinal hernias. A total of 132 hernia repairs followed one previous repair, 41 followed two repairs, 17 followed three repairs, 6 followed four, 3 followed five, and 1 followed six previous repairs. The surgical technique is described. Follow-up ranged from 9 to 31 months (mean 18.4). Twelve patients (6%) had groin seromas or hematomas; 3 (1.5%) had transient thigh numbness. One patient (0.5%) underwent laparoscopy a second time because of a large hematoma. In 1 patient (0.5%), a staple on the n. cutaneus femoris lateralis was removed laparoscopically. Patients described postoperative pain as being much less severe compared with their previous operation. Of the total group, 76% of patients were able to return to work within 2 weeks of surgery. One recurrence (0.5%) occurred after 6 months because of too small a prosthetic mesh. This laparoscopic technique can be applied to recurrent hernias, even in difficult cases, with low morbidity rates. Recurrence rates as low as for laparoscopic repair of primary hernias can be expected.

Long-term results of giant prosthetic reinforcement of the visceral sac for complex reicurrent inguinal hernia

The results of recurrent inguinal hernia repair in a prospective cohort study were evaluated. From May 1986 to December 1990 75 patients with 150 hernias (24 primary, 126 recurrent) were operated using a technique based on Stoppa's proportional mesh repair (giant prosthetic reinforcement of the visceral sac; GPRVS). All patients were at high risk for recurrence: they all had bilateral hernias, mostly bilateral recurrent and often repeatedly recurrent. 411 patients had a physical examination 1 week, 6 weeks and 1 year after operation. Sixty patients (94 per cent of surviving patients) had a physical examination after a mean follow-up of 5.7 (range 4–9) years. There were no major complications. There was one deep infection that healed without removing the mesh. One of the 75 patients (1 per cent) had a recurrence 2 months after the operation, due to a technical failure. Because of the excellent results, the ease of the procedure and the low complication rate, GPRVS is the authors' operation of choice for any recurrent inguinal hernia.

Laparoscopic repair of recurrent hernias.

The purpose of this study was to evaluate the results of a laparoscopic approach to recurrent inguinal hernia repair which dissected the entire inguinal floor and repaired all potential areas of recurrence without producing tension. Both a transabdominal preperitoneal and a totally extraperitoneal laparoscopic approach were utilized. Ninety recurrent hernias were repaired in 81 patients. The patients had 26 indirect, 36 direct, and 26 pantaloon recurrent hernias of which eight had a femoral component. In all but one patient the primary operations were open anterior repairs. The median follow-up was 14 months, ranging from 1 to 28 months. Patients returned to normal activities in an average of 1 week. The only recurrence observed was in the one patient whose primary repair was laparoscopic. When the entire inguinal floor of the recurrent hernia was redissected and buttressed with mesh, early recurrence was eliminated and recovery was shortened.

A technique for repair of recurrent indirect inguinal hernias

The repair of a recurrent inguinal hernia can be a technically demanding operation. Due to scar tissue from prior surgery, injury to the spermatic cord or compromise of the testicular blood supply is possible. A technique for repair of recurrent indirect inguinal hernia that allows minimal dissection of the spermatic cord structures is described.

Recurrent Inguinal Hernia Treated by Classical Hernioplasty

The treatment of recurrent inguinal hernia by classical hernioplasty, ie, via the anterior approach and using endogenous tissue for repair, was evaluated in 163 patients operated on between 1980 and 1987. One hundred fifteen patients had a first recurrence and 48 had a multiple recurrence; 58% were of the direct type; 30% were of the indirect type; 7% were of the combined type; and 5% were not defined. In 1989 a questionnaire was sent to all patients; those indicating symptoms of recurrence underwent further examination. There was a mean follow-up of 52 months and a total follow-up period of 706 years. Thirty-seven patients had a repeated recurrence with a cumulative recurrence rate of 16%, 21%, and 23%, after 1, 2, and 5 years, respectively. Increase of age and time passed since the last repair reduced the recurrence rate. Increased abdominal pressure, type of anesthesia or surgical technique, and wound hematoma had no effect. It is concluded that the technique of classical hernioplasty as such may be unsuitable for repair of recurrent inguinal hernias.

Bilaterality and the prosthetic repair of large recurrent inguinal hernias

From 1966 to 1977, 396 men aged 25 to 89 years (mean 58) underwent 505 repairs for recurrent inguinalguinal herniation (including bilateral defects and recurrences). Since by 1972 it was realized that the approach precluded an effective relaxing incision, when this was indicated (66 per cent) a Marlex prosthesis was used. Seventy-four patients underwent 83 repairs with this material; 26 (35 per cent) had had previous repairs for recurrence, 29 (40 per cent) underwent contralateral herniorrhaphy, whereas another 12 (16 per cent) underwent bilateral repair. Fifty-five (2 of 3) protrusions were direct. None of the patients died. Although overall 110 (22 per cent) of the operations failed, only 6 of 83 hernias (7 per cent) in which Marlex was used recurred, with a mean follow-up study of 4 years. It is important to use a large enough piece of plastic and remove attenuated fascia from around the defect. No infection or extrusion occurred. Preperitoneal placement of Marlex is recommended for difficult, repeatedly recurrent inguinal hernias.

Simplified repair of femoral and recurrent inguinal hernias by a “plug” technic

A new technic for the repair of femoral and recurrent inguinal hernias is presented. The use of a polypropylene mesh “plug” to occlude the defect corrects the hernia without extensive dissection. A five year experience has verified the efficacy of this simplified procedure.

The Use of Fascial Strips in the Repair of Recurrent Inguinal Hernia

The Use of Fascial Strips in the Repair of Recurrent Inguinal Hernia