Laparoscopic repair of recurrent hernias

Background: Recurrence after primary conventional inguinal herniorrhaphy oc curs in approximately 10% of patients depending on the type of repair and e xpertise of the surgeon. The repair of the resulting recurrent hernia is a daunting task because of already weakened tissues and obscured and distorte d anatomy. The failure rate of these repairs using an open anterior approac h may reach as high as 36%. Because of such a high failure rate, a number o f investigators have focused on repairing these difficult recurrent hernias laparoscopically using a tension-free approach. Some of the earlier report s suggested a low recurrence rate of 0.5% to 5% when a laparoscopic approac h was used to repair these hernias. The purpose of this study was to evalua te the efficacy of laparoscopic treatment for recurrent hernias in our inst itutions. Methods: Between February 1991 and February 1995, 96 recurrent hernias were repaired in 85 patients (78 men and 7 women). There were 48 right, 26 left , and 11 bilateral hernias. The mean age of the patients was 59 years (rang e, 18-86 years); the mean height was 69 in. (range, 54-77 in.); and the mea n weight was 176 pounds (range, 109-280 pounds). A total of 68 herniorrhaph ies were performed using the transabdominal preperitoneal (TAPP) method: 19 using intraperitoneal on-lay mesh (IPOM) repair and 8 using the total extr aperitoneal (TEP) method. The method of repair in one patient was not recor ded. The mean operating time was 76 min (range, 47-172 min). Thirteen patie nts underwent additional procedures. Results: Long-term follow-up was performed by questionnaire, examination, o r both in 76 patients (85 hernias). Median follow-up time was 27 months (ra nge, 2-56 months). There were four recurrences (2 in IPOM and 2 in TAPP). T hree of these were repaired laparoscopically and one conventionally. There were 20 minor and 14 major complications and no mortality. One conversion o ccurred in the TAPP group. Mean postoperative stay was 1.4 days (range, 0-4 days). It was felt by 92% of the patients that their symptoms were complet ely relieved, whereas 4% of the patients continued to exhibit symptoms for which their hernia was repaired, and 3.6% failed to answer. As reported, 86 % of the patients preferred their laparoscopic repair; 1% preferred the con ventional repair; and 13% failed to reply. Afterward, 77% of the patients r eturned to normal activity, and 35% returned to vigorous activity within 4 weeks of surgery. Satisfaction with laparoscopic repair was expressed by 92 % of the patients, whereas 8% either were dissatisfied or did not answer. I n the end, 95% of the patients stated that they would recommend laparoscopi c hernia surgery to their family and friends. Conclusions: These preliminary data show that laparoscopic repair of recurr ent inguinal hernia is a safe alternative procedure with acceptable rates o f recurrence and complications.