Management of recurrent inguinal hernias: A prospective study of 163 cases

Abstract

There remains debate as to how recurrent inguinal hernias should be managed. This study aimed to establish a management plan for recurrent hernias. From 1991-2000, 163 patients were operated on for recurrent inguinal hernias. The average interval from the initial surgery to recurrence was 46 months (range 10 days-13 years). The initial surgery prior to recurrence was Shouldice and other techniques without mesh in 142 cases, a Stoppa or a Lichtenstein procedure in ten and three cases, respectively, and laparoscopic repair in eight cases. The recurrent hernias were treated with a Shouldice repair in 52 cases (31.9%), the Lichtenstein technique in 48 cases (29.4%), a totally extraperitoneal laparoscopic repair in 40 cases (24.5%), and a Stoppa procedure in 23 (14.1%). The approaches to management evolved with time: the use of prostheses for recurrent hernia repair increased from 10% in 1991 (2/10) to 100% in 2000 (22/22). In contrast, the Shouldice repair decreased from 90% (18/20) in 1991 to 0% (0/22) in 2000. The Lichtenstein technique was first employed in 1993, in patients with a history of a conventional, laparoscopic, or Stoppa repair and has increased to represent 77% of cases (17/22) in 2000. The Stoppa technique has not been used since 1998. The use of a totally extraperitoneal laparoscopic approach went from 11% (2/18) in 1992 (introduction of the technique) to 23% (5/22) in 2000 and is reserved for recurrence after a Lichtenstein procedure or after conventional repair in working and/or physically active patients without any contraindications to general anesthesia. Prosthetic reinforcement has become the norm in the treatment of recurrent hernias. Given a previous conventional repair, the prosthesis can be placed by either an anterior or posterior approach. The approach is dependent on the level of activity and operability of the patient. If the recurrence follows a totally extraperitoneal or a Stoppa procedure, then the Lichtenstein intervention is recommended. A recurrence after a Lichtenstein procedure should be treated by a totally extraperitoneal approach.

Management of Recurrent Inguinal Hernia at a Tertiary Care Hospital of Southern Sindh, Pakistan

“…Literature reports high recurrence of inguinal hernia among sportsmen, with the reported incidence to be as high as 45–55 % [33]. In our series, only two patients were sportsmen, whereas up to 82.2 % were manual workers.…”

“…Laparoscopic hernia repair was introduced as an alternative to conventional treatment for recurrent hernia. Three advantages associated with minimally invasive repair of hernia have been reported: less postoperative pain and disability, mesh placement in preperitoneal space where the hernia is produced, and avoidance of the need to reoperate through scar tissue with the risk of testicular Literature reports high recurrence of inguinal hernia among sportsmen, with the reported incidence to be as high as 45-55 % [33]. In our series, only two patients were sportsmen, whereas up to 82.2 % were manual workers.…”

“…The incidence of recurrent inguinal hernia is not known with certainty, mainly because of a lack of prolonged follow-up. Some of the factors responsible for recurrence include old age, obesity, type of anesthesia, suture material used, method of dealing with the sac, type of repair, and postoperative complications [1][2][3]. Many recurrent hernias remain silent for a very long time.…”

Video-endoscopic Tension-free Groin Hernia Repair via Total Extraperitoneal Approach

“…In our study, lower recurrence rates during follow-up of two years support the success of the video-endoscopic tension-free repair. In previous studies, the recurrence rate was found to be between 0.1% and 4% [13,14]. In tension-free techniques, the posterior wall repair was performed with a synthetic mesh material that may tend to migrate or cause a hernia to recur.…”

Totally Extraperitoneal Approach (TEP) for Inguinal Hernia Repair

“…Laparoendoscopic inguinal hernia repair when compared with open approaches in various trials, either randomized or prospective, revealed significant benefits and advantageous outcomes, such as less postoperative pain, faster recovery and return to physical activity, as well as superior cosmesis [10,11]. Furthermore, during laparoendoscopic hernia repair, the surgeon has the ability to inspect the entire myopectineal orifice and evaluate the presence of other types of hernia, such as a femoral hernia, which may be repaired in the same procedure [12,13]. Although, a variety of laparoendoscopic techniques have been described for the management of groin hernias [14][15][16][17][18][19]; two among them are the most popular regarding inguinal hernioplasty: TAPP and TEP repair.…”