Repair Of Recurrent Inguinal Hernia Research Articles

Laparo-endoscopic versus open recurrent inguinal hernia repair: should we follow the guidelines?

IntroductionOn the basis of six meta-analyses, the guidelines of the European Hernia Society (EHS) recommend laparo-endoscopic recurrent repair following previous open inguinal hernia operation and, likewise, open repair following previous laparo-endoscopic operation. So far no data are available on implementation of the guidelines or for comparison of outcomes. Besides, there are no studies for comparison of outcomes for compliance versus non-compliance with the guidelines.Patients and methodsIn total, 4812 patients with elective unilateral recurrent inguinal hernia repair in men were enrolled between September 1, 2009, and September 17, 2014, in the Herniamed Registry. Only patients with 1-year follow-up were included.ResultsOut of the 2482 laparo-endoscopic recurrent repair operations 90.5% of patients, and out of the 2330 open recurrent repair procedures only 38.5% of patients, were operated on in accordance with the guidelines of the EHS. Besides, on compliance with the guidelines multivariable analysis demonstrated for laparo-endoscopic recurrent repair a significantly lower risk of pain at rest (OR 0.643 [0.476; 0.868]; p = 0.004) and pain on exertion (OR 0.679 [0.537; 0.857]; p = 0.001). Comparison of laparo-endoscopic and open recurrent repair in settings of compliance versus non-compliance with the guidelines showed a higher incidence of perioperative complications and re-recurrences for recurrent repairs that did not comply with the guidelines.ConclusionThe EHS guidelines for recurrent inguinal hernia repair are not yet being observed to the extent required. Non-compliance with the guidelines is associated with higher perioperative complication rates and higher risk of re-recurrence. Even on compliance with the guidelines, the risk of pain at rest and pain on exertion is higher after open recurrent repair than after laparo-endoscopic repair.

Obturator hernia as a frequent finding during laparoscopic pelvic exploration: A retrospective observational study.

Hernia through the obturator canal is usually unsuspected and hence undiagnosed. Patients with obturator hernias present as acute cases of intestinal obstruction secondary to strangulation or incarceration, with high rate of morbidity and mortality due to delayed diagnosis and treatment. The know incidence of obturator hernia is low, representing 0.073% (11 of 15,098) of all hernias repaired at the Mayo Clinic in a retrospective study of 15 years. In this study, we conducted a retrospective analysis of laparoscopic extraperitoneal hernia repairs that were performed between the years 2003 and 2007. All procedures were undertaken by 2 experienced surgeons who performed more than 150 previous surgeries. In 293 patients who underwent repair of bilateral or recurrent inguinal hernia, exploration of the obturator foramen was conducted looking for obturator hernia, which was found in 20 cases (6.82% of patients). The true incidence of obturator hernia is greater than that reported in the literature, and the chances of detecting hernia are greater if an equal number of men and women are scanned could be higher if pelvic scanning was performed.

Tailored anterior tension-free repair for the treatment of recurrent inguinal hernia previously repaired by anterior approach.

The purpose of this study is to describe our policy in selecting different types of anaesthesia and anterior tension-free techniques for the repair of recurrent inguinal hernias previously treated by anterior approach and to evaluate early and late outcomes. The medical records of 111 patients who underwent recurrent inguinal hernia repair by anterior approach in the period 2000-2013 were reviewed. Fifty patients (45%) were over 70years old and 63 (56.7%) had one or more co-morbidities. Hernias with large defects were the most frequently observed (59.5%), and no-mesh techniques were the most frequent failed repair (75.7%). Different anterior tension-free techniques and types of anaesthesia were used, depending on hernia and patient characteristics. Seventy-three patients (65.8%) were operated on an outpatient basis. Mean follow-up period was 89months (range 10-183). No perioperative deaths, medical events, or visceral injuries were recorded. Early postoperative complications occurred in 11 patients: 4 haematomas (3.6%), 5 seromas (4.5%), 1 superficial wound infection (0.9%) and 1 ischemic orchitis (0.9%). Late complications consisted in 3 cases of chronic moderate pain (3.2%) and 2 re-recurrences (2.1%). Recurrent inguinal hernia previously treated by open anterior technique can be repaired using the same approach, often on an outpatient basis, with a low rate of recurrence and postoperative complications. To be safe and effective, the repair should be performed by appropriately trained surgeons, well versed in the use of different types of anaesthesia and surgical techniques depending on patient and hernia characteristics.

Recurrent inguinal hernia in Ile-Ife Nigeria: Characteristics and outcome of management

Background: There are very few reports addressing patients' characteristics, patterns, and outcome of treatment of recurrent inguinal hernia irrespective of the method of hernia repair. Purpose: The purpose of this study is to evaluate the patients and disease characteristics, treatment and early outcome of surgery for recurrent inguinal hernia. Patients and Methods: The medical records of patients who had repair of recurrent inguinal hernia at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife from January 1, 2004, to December 31, 2013 were reviewed for demographics, number and place of previous repair, technique of repair, intraoperative findings at repair of recurrence, and outcome of this intervention. Data generated were analyzed for frequencies, percentages and Fisher exact test for statistical significance. Results: Forty-one recurrent hernia repairs were done during the period, constituting 3.2% of all hernia repaired. The male:female ratio was 40:1. Mean age was 56.1 ± 17.7 years. Most cases were first-time recurrences 36 (87.8%), reducible 35 (85.4%) and were electively repaired. Six (14.6%) were complicated requiring emergency repair. Recurrence within 1 year of earlier repair was common (36.6%). Relatively, more patients 22 (53.7%) had their primary repair in nonspecialist centers (P

Laparoscopic management of recurrent inguinal hernia in childhood

BackgroundOpen repair of recurrent inguinal hernias [RIH] in infancy and childhood is difficult and there is definite risk of damaging the vas deferens and testicular vessels. Laparoscopic repair of RIH has the benefit of avoiding the previous operative site. The aim of this study is to present our experience with laparoscopic repair of RIH either after open or laparoscopic hernia repair with stress on technical refinements to prevent recurrence. Patients and methodsThis is a retrospective study of laparoscopic repair of RIH. Records of 38 patients with 42 recurrent hernial defects that have been subjected to laparoscopic inguinal hernia repair [LIHR] for RIH were reviewed and evaluated. The primary outcome measurements of this study include; operative time and recurrence rate. The secondary outcomes include intraoperative and postoperative complications, hydrocele formation and testicular atrophy. ResultsIn this study 38 children with 42 recurrent hernial defects [4 patients had bilateral recurrent hernia] were operated upon laparoscopically. They were 34 males and 4 females with a mean age of 2.54±1.989years (range=0.58–10.00years). In 35 hernial defects the recurrence developed after open herniotomy, while in 7 hernial defects it occurred after laparoscopic repair. All procedures were completed laparoscopically without any conversion and there were no intraoperative or postoperative complications during this study. Mean operating time was 15±2.3minutes for unilateral and 20±1.7minutes for bilateral inguinal hernia. All patients achieved full recovery and were discharged on the same day of admission. Two patients developed hydroceles that responded well to conservative management. At mean follow-up of 12.7±2months (range=8–38.4months), there was no recurrence, no testicular atrophy. ConclusionLaparoscopic repair of RIH in infancy and childhood is an attractive option that avoids the difficulties of redo surgery in scarred operative field with delicate structures liable to injury even with expert operator.

Endoscopic repair of primary versus recurrent male unilateral inguinal hernias: Are there differences in the outcome?

Introduction To date, there are no prospective randomized studies that compare the outcome of endoscopic repair of primary versus recurrent inguinal hernias. It is therefore now attempted to answer that key question on the basis of registry data.Patients and methodsIn total, 20,624 patients were enrolled between September 1, 2009, and April 31, 2013. Of these patients, 18,142 (88.0 %) had a primary and 2482 (12.0 %) had a recurrent endoscopic repair. Only patients with male unilateral inguinal hernia and with a 1-year follow-up were included. The dependent variables were intra- and postoperative complications, reoperations, recurrence, and chronic pain rates. The results of unadjusted analyses were verified via multivariable analyses.ResultsUnadjusted analysis did not reveal any significant differences in the intraoperative complications (1.28 vs 1.33 %; p = 0.849); however, there were significant differences in the postoperative complications (3.20 vs 4.03 %; p = 0.036), the reoperation rate due to complications (0.84 vs 1.33 %; p = 0.023), pain at rest (4.08 vs 6.16 %; p < 0.001), pain on exertion (8.03 vs 11.44 %; p < 0.001), chronic pain requiring treatment (2.31 vs 3.83 %; p < 0.001), and the recurrence rates (0.94 vs 1.45 %; p = 0.0023). Multivariable analysis confirmed the significant impact of endoscopic repair of recurrent hernia on the outcome.ConclusionComparison of perioperative and 1-year outcome for endoscopic repair of primary versus recurrent male unilateral inguinal hernia showed significant differences to the disadvantage of the recurrent operation. Therefore, endoscopic repair of recurrent inguinal hernias calls for particular competence on the part of the hernia surgeon.

Long-term outcome for open preperitoneal mesh repair of recurrent inguinal hernia

AimRecurrent inguinal hernia represents a major challenge for surgeons with high risks of re-recurrence and complications, especially when an anterior approach is adopted. The aim of this study was to evaluate the long-term results of the open preperitoneal mesh repair for recurrent inguinal hernia. MethodsWe performed a prospective clinical study of 107 consecutive patients having recurrent inguinal hernias between April 2006 and November 2010. All patients were operated on using open preperitoneal mesh repair. The demographics, perioperative variables, complications and recurrences were evaluated with all patients. ResultsThere were no major intraoperative complications. The average operative time was 42.1 min (range 28–83 min) for unilateral and 62.7 min (range 38–106 min) for bilateral hernias. The mean postoperative hospital stay was 1.6 days (range 1–9 days). The overall complication rate was 8.4%. There were two superficial wound infections, two groin seroma and three urinary retention. The mean follow-up time was 42.3 months (range 28–73 months), three patients developed hernia recurrence. No testicular, chronic pain or mesh-related complications were noted in these series. ConclusionOpen posterior preperitoneal mesh repair offers a viable option for recurrent inguinal hernias and achieves equally effective results to laparoscopic approaches with acceptable complication and recurrence rates. It is safer and easier to learn than laparoscopic repair and has become the preferred approach for treatment of the majority of recurrent inguinal hernias at our institution, especially useful for complex multirecurrent hernias and patients with cardiopulmonary insufficiency.

Laparoscopic transabdominal preperitoneal approach for recurrent inguinal hernia: A randomized trial.

INTRODUCTION:The repair of the recurrent hernia is a daunting task because of already weakened tissues and distorted anatomy. Open posterior preperitoneal approach gives results far superior to those of the anterior approach. Laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair is an evolving technique associated with advantages of a minimally invasive approach. The present work aimed at comparing these three approaches for repair of recurrent inguinal hernia regarding complications and early recurrence.MATERIALS AND METHODS:A total of 180 patients were divided randomly into three equal groups: A, B, and C. Group A patients were subjected to open posterior preperitoneal approach , those of group B were subjected to transinguinal anterior tension-free repair and group C patients were subjected to TAPP. The primary end point was recurrence and the secondary end points were time off from work, postoperative pain, scrotal swelling, and wound infections.RESULTS:The mean hospital stay, the mean time to return to work and the mean time off from work were less in group C then A and B. Chronic postoperative pain was observed in eight patients in group A (13.33%), in 18 patients in group B (30%) and six patients in group C (10%). The overall complication rate was 19.7% in both groups A and C and 34.36% in group B.CONCLUSION:In recurrent inguinal hernia, the laparoscopic and open posterior approaches are equally effective in term of operative outcome. The open preperitoneal hernia repair is inexpensive, has a low recurrence rate. Postoperative recovery is short and postoperative pain is minimal. This approach gives results far superior to those of the commonly used anterior approach. However, while laparoscopic hernia repair requires a lengthy learning curve and is difficult to learn and perform, it has advantages of less post-operative pain, early recovery with minimal hospital stay, low post-operative complications and recurrence.Trial RegistrationACTRN12613001050741

Single-port onlay mesh repair of recurrent inguinal hernias after failed anterior and laparoscopic repairs.

Background and Objectives:Despite the exponential increase in the use of laparoscopic inguinal herniorrhaphy, overall recurrence rates have remained unchanged. Therefore, a growing number of patients are presenting with recurrent hernias after conventional anterior and laparoscopic repairs have failed. This study reports our experience with single-incision laparoscopic (SIL) intraperitoneal onlay mesh (IPOM) repair of these hernias.Methods:Patients referred with two or more recurrences of inguinal hernia underwent SIL-IPOM from November 1, 2009, to June 24, 2014. A 2.5-cm infraumbilical incision was made, and an SIL port was placed intraperitoneally. Modified dissection techniques were used: chopstick and inline dissection, 5.5-mm/52-cm/30° angled laparoscope, and conventional straight dissecting instruments. The peritoneum was incised above the pubic symphysis, and dissection was continued laterally and proximally, raising the inferior flap below the previous extraperitoneal mesh while reducing any direct, indirect, femoral, or cord lipoma before placement of antiadhesive mesh, which was fixed to the pubic ramus, as well as superiorly, with nonabsorbable tacks before the inferior border was fixed with fibrin sealant. The inferior peritoneal flap was then tacked back onto the mesh.Results:Nine male patients underwent SIL-IPOM. Their mean age was 53 years and mean body mass index was 26.8 kg/m2. Mean mesh size was 275 cm2. Mean operation time was 125 minutes, with a hospital stay of 1 day. The umbilical scar length was 23 mm at the 6-week follow-up. There were no intra-/postoperative complications, port-site hernias, chronic groin pain, or recurrence of the hernia during a mean follow-up of 24 months.Conclusion:Inguinal hernias recurring after two or more failed conventional anterior and laparoscopic repairs can be safely and efficiently treated with SIL-IPOM.

Recurrent inguinal hernia repair: what is the evidence of case series? A meta-analysis and metaregression analysis.

To examine, if case series considered together with observational studies tend to produce similar results as randomized-controlled trials (RCTs), on recurrent hernia repair. A systematic literature review and meta-analysis between 1990 and 2013 revealed 46 nonrandomized studies (NRCTs) and 5 RCTs including 25,730 patients. A direct comparison of the summary estimates between RCTs and NRCTs is presented. Outcomes, within or across studies, were compared. Comparisons of all outcomes in NRCTs and RCTs failed to show statistical significance. Prospective/retrospective cohort studies, case series, and RCTs did not differ significantly in their estimates. Adjusted testing for metaregression disclosed that rerecurrence among NRCTs was independent of the study design. The number of included patients and study setting were independent predictors of outcome. Our proposed methodology for a systematic review could potentially give answers where level I evidence is missing or could be a tool for optimization of a RCT design.

Efficacy of the open anterior prosthetic repair in the surgical management of recurrent inguinal hernia in old patients

Background To date no standard treatment for recurrent ingunal hernias exists. Open or laparoscopic approaches were proposed with apposition of meshes with reknown advantages and limits [1]. Long term recurrence-rate, postoperative pain, fistulization or prosthetic infection risks remain open questions in this surgery. Aim of this work is to show results of our experience with the open anterior approach in local anesthesia[2] for recurrent inguinal hernia repair in old patients (Age>75 yrs).

Laparoscopic totally extraperitoneal versus open preperitoneal mesh repair for inguinal hernia recurrence: a decision analysis based on net health benefits

The aim of this study is to evaluate the most cost-effective treatment strategy using preperitoneal mesh for patients with recurrent inguinal hernia. Currently, the issue of cost-effectiveness is entirely unresolved. A decision analysis was carried out based on the results of a systematic literature review of articles concerning recurrent inguinal hernia repair that were published between 1979 and 2011. A virtual cohort was programmed to undergo three different treatment procedures: (1) laparoscopic totally extraperitoneal hernia repair (TEP), (2) open preperitoneal mesh repair according to Stoppa, and (3) open preperitoneal mesh repair according to Nyhus. We carried out a base-case analysis and varied all variables over a broad range of reasonable hypotheses in multiple one-way and two-way sensitivity analyses. The average cost-effectiveness ratio of Nyhus, Stoppa, and TEP per quality-adjusted life year was US $ ($)1,942, $1,948, and $2,011, respectively. In terms of the incremental cost-effectiveness ratio (ICER), Stoppa was dominated. The choice between TEP or Nyhus procedure depends on the combination of a specific center's rates of recurrence and morbidity as disclosed by three-way sensitivity analysis. Nyhus and TEP repairs are possible optimal choices depending primarily on the institution's rates of recurrence and morbidity. Based on our net benefit-related decision analysis, a hypothetical "fixed budget trade-off" suggests potential annual incremental health system cost savings of $200,000 attained by shifting care for 1,000 patients from TEP to Nyhus repair (depending on clinical end-points, which is a decisive factor).

Comparison of open preperitoneal mesh vs. LichtensteinTechnique for repair of recurrent inguinal hernia

Comparison of open preperitoneal mesh vs. LichtensteinTechnique for repair of recurrent inguinal hernia

Laparoscopic or Lichtenstein repair for recurrent inguinal hernia: a meta‐analysis of randomized controlled trials

There is no clear answer regarding the use of laparoscopic techniques versus the Lichtenstein method for the treatment of recurrent inguinal hernia. The aim of this study was to compare the outcomes of laparoscopy versus the Lichtenstein repair by a meta-analysis of available randomized controlled trials (RCTs). Databases, including PubMed, EMBASE, the Cochrane Library, and the Science Citation Index updated to May 2012, were searched. The main outcome measures were wound infections and haematoma, urinary retention, post-operative chronic pain and recurrence. A meta-analysis of included RCTs was performed. Five RCTs, comprising a total of 427 patients, were included. Although most of the analysed outcomes were similar between groups, wound infection rates and post-operative chronic pain occurred less frequently in the laparoscopic group than in the Lichtenstein group (odds ratio: 0.28, 95% CI: 0.08-0.97; P = 0.05; odds ratio: 0.33, 95% CI: 0.17-0.68; P = 0.002, respectively). The laparoscopic approach to the treatment of recurrent inguinal hernia is superior to the Lichtenstein hernioplasty in some aspects that affect patient satisfaction.

Open preperitoneal versus anterior approach for recurrent inguinal hernia: a randomized study

BackgroundInguinal herniorrhaphy remains one of the most common general surgical operations, with approximately 15% performed for recurrence. The repair of the resulting recurrent hernia is a daunting task because of already weakened tissues and obscured and distorted anatomy. The aim of this study is to compare the posterior preperitoneal versus anterior tension-free approach for repair of unilateral recurrent inguinal hernia regarding complications and early recurrence.Methods120 Patients in this study were divided randomly into 2 main groups; Group A patients were subjected to posterior preperitoneal approach and those of group B were subjected to conventional anterior tension-free repair. The primary end point was recurrence and the secondary end points were time off from work, postoperative pain, scrotal swelling and wound infections.ResultsThe mean hospital stay was 1.2 days and 4.7, the mean time to return work was 8.2 and 11.2 days and the mean time off from work was 9.4 and 15.9 days in group A and B respectively. The maximum follow-up period was 48 months and the minimum was 14 months with a mean value as 37.11 ± 5.14 months. Only 2 recurrences (3.3%) in group A and 4 cases (6.25%) in group B were seen. The final pain score per patient and the overall complication rate were higher in group B.ConclusionsThe open preperitoneal repair offers the advantages of low recurrence rate and allows covering all potential defects with one piece of mesh and is far superior to the anterior approach.Trial RegistrationACTRN12611000337976

Prospective randomized trial of laparoscopic (transabdominal preperitoneal-TAPP) versus open (mesh) repair for bilateral and recurrent inguinal hernia: incidence of chronic groin pain and impact on quality of life: results of 10 year follow-up

The incidence of chronic groin pain (CGP) and its impact on quality of life (QoL) after hernia repair are not clear with follow-up either being short or retrospective. We present 10-year prospective follow-up of a randomized trial for bilateral and recurrent hernia repair focusing on CGP and its impact on QoL. Patients enrolled between 1997 and 2000 were contacted by telephone and asked about the presence of CGP. Those patients with CGP were sent two validated questionnaires: a SF-12v2 Health Survey and a Pain Impact Questionnaire (PIQ-6) (QualityMetric, USA). One hundred and twenty patients were recruited into the original study, and of these, 14 complained of CGP and were sent a PIQ-6 and a SF-12 v2 health survey. Overall, there was a higher incidence of CGP in the laparoscopic group compared with the open group (15 vs. 8%, ns), but the severity of the pain in the laparoscopic group was less (2 vs. 3.5, p=0.0558). QoL was significantly reduced in patients with CGP compared with the US norm. The laparoscopic group scored higher in 5 out of 8 of the QoL categories compared with the open group, but this was not significant. Overall age-adjusted scores revealed those under 65years of age felt they had poorer physical health, and this reduced their QoL compared to normal values. CGP following laparoscopic surgery for inguinal hernia repair is less severe than open repair, but this does not translate into a significant improvement in QoLin this study.

Transplant ureteric stenosis complicating laparoscopic recurrent inguinal hernia repair

Ureteric obstruction of the transplanted kidney is the most common late urological complication and is caused mostly by ureteric stricture. We report the case of a patient who developed ureteric obstruction following trans-abdominal pre-peritoneal repair of a recurrent inguinal hernia (TAPP). High level evidence exists to support the laparoscopic approach to recurrent inguinal hernia repair; however, this case reports the potential complications and difficulties that may occur in the presence of a kidney transplant.

Single-incision laparoscopic transabdominal preperitoneal herniorrhaphy for recurrent inguinal hernias: preliminary surgical results

Since the early 1990s, laparoscopy has provided surgeons with new and innovative ways to treat various surgical problems. Many of these minimally invasive techniques have gained universal acceptance by demonstrating improved patient outcomes. Single-incision laparoscopic surgery (SILS) was developed with the aim of reducing the invasiveness of traditional laparoscopy. Laparoscopic transabdominal preperitoneal (TAPP) herniorrhaphy via the three-trocar technique is widely used for recurrent inguinal hernia. To the author's knowledge, this report describes first series of SILS TAPP for recurrent inguinal hernia repair. From April 2009 to March 2010, 15 single-incision laparoscopic TAPP repairs of recurrent inguinal hernia were performed by the same surgical team. The data collected prospectively included patient demographics, type of hernia, operative time, complications, postoperative hospital stay, and recurrence. The umbilicus was the sole point of entry for all patients using a single port, and the same operative technique was used in all cases. The SILS TAPP procedure was performed successfully for all the patients, and none required conversion to an open procedure or a conventional laparoscopic hernia repair by the addition of more entry ports. The mean operative time was 51 ± 17 min. No intra- or postoperative complications were recorded. There was no evidence of early recurrence during a mean follow-up period of 130 ± 77 days. Based on this experience, the author believes that SILS approach is technically feasible and safe using standard and slightly modified instruments for standard TAPP. The cosmetic benefit is clear, but the advantages of SILS TAPP over conventional laparoscopic surgery during long-term follow-up evaluation will require further randomized clinical trials.

A comparison of outcomes between open and laparoscopic surgical repair of recurrent inguinal hernias

Inguinal hernia recurrence after surgical repair is a major concern. The authors report their experience with open and laparoscopic repair of recurrent inguinal hernias. After institutional review board approval, a retrospective review was performed with the charts of 197 patients who had undergone surgical repair of recurrent inguinal hernias from January 2000 through August 2009, and the data for 172 patients who met the inclusion criteria were analyzed. Surgical variables and clinical outcomes were compared using Student's t test, the Mann-Whitney U test, chi-square, and Fisher's exact test as appropriate. The review showed that 172 patients had undergone either open mesh repair (n=61) or laparoscopic mesh repair (n=111) for recurrent inguinal hernias. Postoperative complications were experienced by 8 patients in the open group and 17 patients in laparoscopic group (p=0.70). Five patients (8.2%) in the open group and four patients (3.6%) in the laparoscopic group had re-recurrent inguinal hernias (p=0.28). Four patients in the open group (9.5%) and no patients in the laparoscopic group had recurrence during long-term follow-up evaluation (p=0.046). In the laparoscopic group, 76 patients (68.5%) underwent total extraperitoneal (TEP) repair, and 35 patients (31.5%) had transabdominal preperitoneal (TAPP) repair. Postoperative complications were experienced by 13 patients in the TEP group and 4 patients in the TAPP group (p=0.44). Two patients (2.6%) in the TEP group and two patients (5.7%) in the TAPP group had re-recurrent inguinal hernias (p=0.59). This retrospective review showed no statistical difference in the re-recurrence rate between the two techniques during short-term follow-up evaluation. However, the laparoscopic technique had a significantly lower re-recurrence rate than the open technique during long-term follow-up evaluation. Both procedures were comparable in terms of intra- and postoperative complications. Among laparoscopic techniques, TEP and TAPP repair are acceptable methods for the repair of recurrent inguinal hernia. A multicenter prospective randomized control trial is needed to confirm the findings of this study.

Incidental Finding at Screening Colonoscopy: Mesh Penetration of the Sigmoid Colon - Another Life-saving Role for Colonoscopy

Purpose: Foreign bodies in the colon are rare and are mostly either swallowed by mouth or self administered through the anus. Penetrating foreign bodies through the wall of the colon are extremely rare. We report a case of mesh penetration of the sigmoid colon found during screening colonoscopy. 53 year old asymptomatic male patient presents for his first screening colonoscopy. Seven years prior to his procedure he underwent laparoscopic transabdominal preperitoneal (TAPP) repair of recurrent inguinal hernia three years following bilateral inguinal hernia repair by traditional Marcy herniorapphy. During insertion of the colonoscope a foreign body consistent with a mesh-like structure was seen in the sigmoid colon 30 cm from the anal verge. The mesh was seen penetrating at least 3 cm within the colon with surrounding ulceration (see Figure). The rest of the colon was unremarkable and there were no post procedural complications. CT scan confirmed the penetration of the mesh through the wall of the colon without abscess or collection. The patient was referred for colorectal surgery and planned for segmental resection. Laparoscopic transabdominal preperitoneal (TAPP) repair of inguinal hernia is a well described technique associated with low rate of recurrence and complications. Postoperative complications include mesh infections,nerve damage and less commonly intestinal obstruction from bowel adhesions, trocar hernias, seromas, hematomas and scrotal emphysema.There are only two previously described cases of mesh perforation of the colon which were discovered after the patients presented with persistent inguinal pain, diarrhea and anal bleed. In our case the mesh penetration was identified in a completely asymptomatic patient. Management of these patients involved in one case laparotomy with mesh removal and segmental sigmoidectomy and in the other case a colonoscopic extraction of the mesh. Colonoscopy may play a role both in the diagnosis and treatment of mesh penetration and migration considering potential complications which may result like abscess formation, sepsis and bowel perforation with peritonitis.