Vadim P. Koshenkov, MD, (left) received the Michael S. Kavic (left) Award for Best Resident Paper for his abstract submission to the SLS 19th Annual Meeting and Endo Expo 2010
Laparoscopic Approach After Laparoscopic Inguinal Hernia Recurrence
Khaled El Zarrok Elgazwi, MD, PhD, Prof. Ivo. Baca, MD, PhD, Akrem Elshakhy, MD, Arash Khani, MD
Klinikum Bremen ost. Bremen, Germany
Background: Recurrent inguinal hernias have occurred after endoscopic inguinal hernia repair, although far less frequently than after conventional repair (in the literature between 0.1% to 1.5%). The aim of this study was to evaluate whether these recurrences can be repaired by using the laparoscopic approach with acceptable complication and recurrence rates.
Methods: From August 1993 through May 2008, approximately 3823 inguinal hernia patients with 4746 hernias were operated on endoscopically at our institution; 3443 were males and 380 were females. Their age at surgery ranged from 20 years to 93 years. Forty-five patients with recurrent inguinal hernias on physical examination underwent surgery at our institutions. All the recurrences occurred following endoscopic inguinal hernia repair with mesh prostheses. The recurrences were repaired endoscopically by using a transabdominal approach. Depending on the size of the defect, a new polypropylene mesh was used.
Results: Mean surgery time was 48 minutes. There were no conversions to the anterior approach. After a mean follow-up of 12 months, no recurrences had been diagnosed. Mean hospital stay was 1.5 days (range, 1 to 3).
Conclusion: There is a place for laparoscopic surgery in the treatment of recurrent inguinal hernias after endoscopic herniorrhaphy. The transabdominal preperitoneal approach is a reliable technique for recurrent inguinal hernia repair after previous endoscopic herniorrhaphy.
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