Clinical usefulness of laparoscopic total extraperitoneal hernia repair for recurrent inguinal hernia

Abstract

PurposeHernia repair after recurrence is a challenging procedure, and many approaches have been suggested for it. Total extraperitoneal (TEP) hernia repair should be considered in recurrent hernia. This study was conducted for the purpose of investigating the clinical usefulness of laparoscopic TEP hernia repair for recurrent inguinal hernia.MethodsAmong the 191 patients who underwent TEP hernia repair at these authors' center from June 2006 to January 2010, the bilateral-hernia cases and the patients with a history of previous pelvic surgery were excluded. A total of 19 patients (12.5%) were enrolled in the recurrent-inguinal-hernia group (group R), and 133 patients (87.5%) in the primary-hernia group (group P). Data were investigated retrospectively, based on the medical records.ResultsThe mean operation time was 97 minutes in group R and 99 minutes in group P (>0.05). In group R, no operation modality change occurred, and temporary urinary retention was developed in four patients (21.1%). In group P, on the other hand, operation modality change from TEP to the transabdominal preperitoneal approach was necessary in four patients (3%). Additionally, in group P, 30 patients (22.6%) had temporary urinary retention and six (4.5%) had testicular edema. No recurrence was identified during the follow-up period in both groups (mean follow-up period: 15.8 months for group R and 18.0 months for group P).ConclusionLaparoscopic TEP hernia repair seems to be a safe and useful method for correcting recurrent inguinal hernia.

Bilateral Laparoscopic Totally Extraperitoneal Repair Without Mesh Fixation

“…In comparison with the available literature about laparoscopic TEP repair, 9–11,14–26 our patients had fewer intraoperative and postoperative complications, less chronic pain, and no increase in operative time or length of hospital stay but did have a slight increase in recurrence rate.…”

“…We have described the experience of a single surgeon performing bilateral laparoscopic TEP repair of 686 primary and recurrent inguinal hernias without mesh fixation in a series of 343 consecutive patients at our institution over a 6-year period. In comparison with the available literature about laparoscopic TEP repair, 9 – 11 , 14 – 26 our patients had fewer intraoperative and postoperative complications, less chronic pain, and no increase in operative time or length of hospital stay but did have a slight increase in recurrence rate.…”

“…14 Laparoscopic TEP repair of recurrent hernias is usually challenging because of tissue scarring and distorted anatomy that often require longer and more careful dissection. In a prospective study of 19 patients with recurrent unilateral inguinal hernias who underwent laparoscopic TEP repair, Jang et al 15 reported a mean operative time of 100 minutes. Similarly, the complexity of the hernia affects the operative time because more time is needed for identification and reduction of all hernia contents safely and effectively.…”

Comparison of Lichtenstein and total extraperitoneal laparoscopic hernia repair (TEP) methods in inguinal hernias

“…IS Jang et al [5] applied TEP to two groups of primary and recurrent inguinal hernia and compared them according to operation duration and morbidity. As a result, no significant difference was found between two groups and TEP was stated to be a safe method in recurrent inguinal hernias.…”

Outcome of the patients with chronic mesh infection following open inguinal hernia repair

“…The reason for this high recurrence rate may be associated with the limited number of patients. Laparoscopic total extraperitoneal hernia repair has been considered a safe and effective surgical approach for recurrent hernia following an anterior technique [27]. …”