Background. Relaparoscopic treatment of inguinal hernia recurrences has become a relatively new concept with favourable results. The purpose of this study was to examine a series of relaparoscopic repair, present technical experiences, and the clinical outcomes in this subset of patients. Patients and Methods. The medical records of five patients who underwent relaparoscopic repair (TAPP or TEP) for a recurrence between March 2005 and September 2012 were retrospectively reviewed. Results. All the patients were male with a mean age of 45 years. Technical failures in the previous repairs were the main factors contributing to recurrences. In two re-TEP cases with no previous mesh fixation, the old mesh remained on the peritoneal side during preperitoneal dissection and this greatly facilitated surgical manipulation. The mean operative time was 93？min (range, 45–120？min). There were no conversions, no intraoperative complications, and no morbidity or rerecurrence after a mean follow-up period of 17 months (range, 7–24 months). Conclusion. Relaparoscopic repair appears to be safe and effective in the treatment of recurrent inguinal hernia and repeated TEP could be a simpler approach than expected in the presence of no prior mesh fixation. 1. Introduction Inguinal hernia repair is one of the most frequently performed operations in general surgery. With the introduction of laparoscopy in hernia surgery in 1990s, laparoscopic posterior repair (transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP)) has gained increasing popularity and emerged as the procedure of choice over open conventional techniques due to its well-established advantages such as lower rates of postoperative pain, rapid return to normal activities, and a lower incidence of infections. The major concern after inguinal hernia repair is recurrence. Recurrence rate after laparoscopic repair is comparable to that of open conventional techniques; however, such recurrences do occur after a laparoscopic repair with a reported rate of up to 5% [1, 2]. It is recommended that anterior mesh repair be performed for a recurrent hernia after previous posterior repair due to the increased risk of complications associated with the repeated posterior repair [3]. However, repeated laparoscopic treatment of hernia recurrences after previous posterior repair has become a relatively new concept and data on an increasing number of reported series has shown promising results with this approach in terms of safety, feasibility, and reliability [4–11]. We performed the first laparoscopic inguinal hernia
References
[1]
M. S. Liem, E. B. van Duyn, Y. van der Graaf, and T. J. van Vroonhoven, “Recurrences after conventional anterior and laparoscopic inguinal hernia repair: a randomized comparison,” Annals of Surgery, vol. 237, no. 1, pp. 136–141, 2003.
[2]
H. R. Langeveld, M. Van't Riet, W. F. Weidema et al., “Total extraperitoneal inguinal hernia repair compared with lichtenstein (the level-trial): a randomized controlled trial,” Annals of Surgery, vol. 251, no. 5, pp. 819–824, 2010.
[3]
M. P. Simons, T. Aufenacker, M. Bay-Nielsen et al., “European Hernia Society guidelines on the treatment of inguinal hernia in adult patients,” Hernia, vol. 13, no. 4, pp. 343–403, 2009.
[4]
E. Felix, S. Scott, B. Crafton et al., “Causes of recurrence after laparoscopic hernioplasty: a multicenter study,” Surgical Endoscopy, vol. 12, no. 3, pp. 226–231, 1998.
[5]
M. T. Knook, W. F. Weidema, L. P. S. Stassen, and C. J. van Steensel, “Laparoscopic repair of recurrent inguinal hernias after endoscopic herniorrhaphy,” Surgical Endoscopy, vol. 13, no. 11, pp. 1145–1147, 1999.
[6]
C. Tamme, H. Scheidbach, C. Hampe, C. Schneider, and F. K？ckerling, “Totally extraperitoneal endoscopic inguinal hernia repair (TEP): results of 5,203 hernia repairs,” Surgical Endoscopy and Other Interventional Techniques, vol. 17, no. 2, pp. 190–195, 2003.
[7]
P. K. Chowbey, S. K. Bandyopadhyay, A. Sharma, R. Khullar, V. Soni, and M. Baijal, “Recurrent hernia following endoscopic total extraperitoneal repair,” Journal of Laparoendoscopic and Advanced Surgical Techniques A, vol. 13, no. 1, pp. 21–25, 2003.
[8]
S. K. Richards, M. N. Vipond, and J. J. Earnshaw, “Review of the management of recurrent inguinal hernia,” Hernia, vol. 8, no. 2, pp. 144–148, 2004.
[9]
G. S. Ferzli, K. Shapiro, S. V. DeTurris et al., “Totally extraperitoneal (TEP) hernia repair after an original TEP: is it safe, and is it even possible?” Surgical Endoscopy and Other Interventional Techniques, vol. 18, no. 3, pp. 526–528, 2004.
[10]
G. S. Ferzli and G. E. Khoury, “Treating recurrence after a totally extraperitoneal approach,” Hernia, vol. 10, no. 4, pp. 341–346, 2006.
[11]
B. van den Heuvel and B. J. Dwars, “Repeated laparoscopic treatment of recurrent inguinal hernias after previous posterior repair,” Surgical Endoscopy, vol. 27, no. 3, pp. 795–800, 2013.
[12]
B. J. Leibl, C. Schmedt, K. Kraft, M. Ulrich, and R. Bittner, “Recurrence after endoscopic transperitoneal hernia repair (TAPP): causes, reparative techniques, and results of the reoperation,” Journal of the American College of Surgeons, vol. 190, no. 6, pp. 651–655, 2000.
[13]
M. T. Knook, W. F. Weidema, L. P. S. Stassen, and C. J. van Steensel, “Endoscopic total extraperitoneal repair of primary and recurrent inguinal hernias,” Surgical Endoscopy, vol. 13, no. 5, pp. 507–511, 1999.
[14]
E. H. Phillips, R. Rosenthal, M. Fallas et al., “Reasons for early recurrence following laparoscopic hernioplasty,” Surgical Endoscopy, vol. 9, no. 2, pp. 140–145, 1995.
