RECURRENT INGUINAL-HERNIA AFTER LAPAROSCOPIC REPAIR - POSSIBLE CAUSE AND PREVENTION

Eleven patients with recurrent inguinal hernia after laparoscopic hern ia repair were referred for treatment. A medial recurrence associated with a mature peritoneal sac was identified in each case. The prosthet ic mesh medial to the inferior epigastric artery had relied away from the pubic ramus to expose Hesselbach's triangle. All cases were succes sfully treated by insertion of a second mesh to cover the defect and o verlap the original mesh. To date there have been no further recurrenc es. Lessons learnt from experience of such laparoscopic transperitonea l hernia repair include that: the prosthetic mesh must be placed so th at it reaches or crosses the midline; at least three staples should fi x the mesh to the pubic ramus; a large mesh (13 x 9 cm) with a greater surface area should reduce the pressure tending to disrupt the mesh; and bilateral hernia is best managed by inserting a single piece of me sh (28 x 9 cm) fully unfolded as it crosses the midline to ensure cove rage of both medial direct defects ('bikini repair'). Application of t hese principles may reduce the incidence of recurrence after laparosco pic inguinal hernia repair.