MECHANISMS OF HERNIA RECURRENCE AFTER PREPERITONEAL MESH REPAIR - TRADITIONAL AND LAPAROSCOPIC

Objective The authors provide an assessment of mechanisms leading to h ernia recurrence after laparoscopic and traditional preperitoneal hern iorrhaphy to allow surgeons using either technique to achieve better r esults. Summary Background Data The laparoscopic and traditional prepe ritoneal approaches to hernia repair are analogous in principle and ou tcome and have experienced a similar evolution over different time fra mes. The recurrence rate after preperitoneal hemiorrhaphy should be lo w (<2%) to be considered a Viable alternative to the most successful m ethods of conventional hemiorrhaphy. Methods Experienced surgeons supp ly specifics regarding the mechanisms of recurrence and technical meas ures to avoid hernia recurrence when using the preperitoneal prostheti c repair. Videotapes of laparoscopic hemiorrhaphy in 13 patients who s ubsequently experienced a recurrence also are used to determine techni cal causes of recurrence. Results Factors leading to recurrence includ e surgeon inexperience, inadequate dissection, insufficient prosthesis size, insufficient prosthesis overlap of hernia defects, improper fix ation, prosthesis folding or twisting, missed hernias, or mesh lifting secondary to hematoma formation. Conclusions The predominant factor i n successful preperitoneal hernia repair is adequate dissection with c omplete exposure and coverage ct ail potential groin hernia sites. Hem atoma mesh lifting and inadequate lateral inferior and medial inferior mesh fixation represent the most common causes of recurrence for surg eons experienced in traditional or laparoscopic preperitoneal hernia r epair.