Hybrid method with explorative laparoscopy and anterior open approach for re-recurrent inguinal hernia

Abstract

The new guidelines of the HerniaSurge group recommend that only an expert hernia surgeon should repair a re-recurrent inguinal hernia. We report the efficacy of the hybrid method with explorative laparoscopy and anterior open approach for re-recurrent inguinal hernia repair. A 61-year-old man underwent anterior open preperitoneal mesh repair for right inguinal direct hernia and laparoscopic transabdominal preperitoneal repair for recurrence. Two years after the second surgery, re-recurrent inguinal hernia was confirmed. We carried out explorative laparoscopy for the re-recurrent inguinal hernia, which revealed a re-recurrent hernia orifice. We performed the anterior open approach while observing from the abdominal cavity. Explorative laparoscopy can help in accurately determining the orifice of the re-recurrent inguinal hernia. Based on that information, the hernia sac can be reached through the shortest route using the anterior open approach.

What is the outcome of re-recurrent vs recurrent inguinal hernia repairs? An analysis of 16,206 patients from the Herniamed Registry

“…Diagnostic laparoscopy can be useful for second recurrences and ≥ third recurrences to decide which surgical access route offers the best outcome prospects for repair of a re-recurrence [ 23 , 24 ]. The laparoscopy findings will make a valuable contribution when deciding whether a laparo-endoscopic procedure or an open technique assures better conditions.…”

Completely laparoscopic repair for recurrent inguinal hernia that developed after open posterior mesh repair

“…3,4 After OPMR, totally extraperitoneal repair or TAPP seems difficult because the previously placed mesh may be an obstacle during the exfoliation of the parietal peritoneum. During exfoliation, these laparoscopic procedures appear likely to cause chronic pain if the "trapezoid of disaster," 1,[3][4][5] to which the previously placed mesh was adhered, especially in TIPPMR, is injured. For these reasons, even in Europe and the United States, surgeons tend to avoid performing CLR for RIH after OPMR for fear of patients developing chronic pain.…”

“…1 As such, CLR for RIH after OPMR is not widely performed. [1][2][3][4][5] However, a meta-analysis showed that the incidence of chronic pain was similar between the open and laparoscopic approaches for RIH. Despite this, open repair for RIH is considered more likely than laparoscopic repair to cause chronic pain.…”

“…However, in Japan, LPR is less common than in Europe and the United States 2 ; rather, open posterior mesh repair (OPMR), including mesh plug repair (MPR) and transinguinal preperitoneal mesh repair (TIPPMR), is the most common open repair. Therefore, completely laparoscopic repair (CLR) for RIH that develops after PAOR has been rarely reported in Japan 3,4 …”

Successful mesh plug repair using a hybrid method for recurrent inguinal hernia after laparoscopic transabdominal preperitoneal approach: A case report

“…Conversely, an anterior approach can be used to treat a recurrent inguinal hernia after a failed posterior approach according to the HerniaSurge Group and European Hernia Society (EHS) guidelines [7]. Sakamoto et al reported the use of a “hybrid method,” i.e., explorative laparoscopy combined with open anterior repair, for a case of re-recurrent hernia after a failed anterior and posterior approach [8]. Although we performed a similar hybrid method on a patient who underwent primary repair via the laparoscopic transabdominal preperitoneal approach (TAPP), our technique is new to recurrent indirect hernia repair.…”