CAUSES OF RECURRENCE AFTER LAPAROSCOPIC HERNIOPLASTY - A MULTICENTER STUDY

Background: To determine if there are common factors beyond the learni ng curve that lead to recurrence after laparoscopic hemioplasty, we an alyzed failures seen in seven centers specializing in laparoscopic her nia repair. Method: We performed a retrospective review of patients wh o had a laparoscopic hernioplasty (Tapp or Tep) between 1990 and 1996 at centers specializing in laparoscopic repairs (>500 repairs at each center). Results: In all, 7661 patients had 10,053 hernias repaired by the transabdominal preperitoneal or the totally extraperitoneal appro ach; they were followed for 1 month to 6 years. In patients followed f or greater than or equal to 6 months with a median follow-up of 36 mon ths, 35 repairs failed (0.4%), and all but one of these patients under went a remedial operation. Twenty-nine had a laparoscopic repair, four had a combined laparoscopic and anterior repair, and one had an anter ior repair alone. The cause of failure was determined in all 34 patien ts. The mechanism of recurrence was inadequate lateral fixation of the mesh in 11 cases, inadequate lateral fixation compounded by too small a mesh in three cases, missed lipoma of the cord in four cases, inade quate fixation of the mesh medially to Cooper's ligament in eight case s (seven of which were associated with too small a mesh), a missed her nia in four cases, and a hernia through a keyhole in the mesh in five cases. As surgeons gained experience, the incidence of recurrence due to missed hernias or too small a mesh decreased. Conclusions: This lar ge multicenter study demonstrated that the incidence of recurrence aft er laparoscopic hernioplasty performed by experienced surgeons was ext remely low and that some causes could be corrected by experience, wher eas others will require changes in technique or equipment.