Article Abstract

Surgical repair in recurrent inguinal hernia

Authors: Anil Sharma, Ankush Sarwal


Background: With 13% of all groin hernia repairs being performed for recurrent hernias, recurrence after inguinal hernia repair remains a clinical problem in present day scenario. All the measures to decrease the burden of recurrences should be used which can only be done by getting the knowledge of patient-related risk factors along with knowledge of the controllable technical risk factors. Number of factors may contribute to the recurrence of an inguinal hernia. These may be classified into patient-related, surgeon-related and sur-gery/technique-related. It is important to have to complete detail about prior surgical history. Clinical evaluation is additionally supported by ultrasound examination of the groin region and if required a MRI or CT to confirm the diagnosis of recurrence.
Methods: Repair of a recurrent inguinal hernia is technically more demanding for the surgeon. The decision would rest on patient preference as well as surgeon choice, and is best made after a detailed discussion with the patient. It is recommended in guidelines to repair the hernia via virgin tissue planes.
Results: For patients with a failed anterior mesh repair, the procedure of choice is to use a posterior approach to the hernia repair. In patients who have undergone a prior posterior hernia repair such as a lap-aroscopic hernia repair, the preferred technique is based on surgeons experience with laparoscopic hernia repair sur-geries. Surgeons who are more experienced with open approach should opt for an open repair and surgeons with more experience for laparo-endoscopic approach should opt for posterior route.
Conclusions: Two meta-analysis studies were done for patients with recurrent inguinal hernias which evaluated the recurrence rate and morbidities for laparoscopic and open repairs. Results showed patients treated with a laparoscopic repair had significantly less pain, fewer superficial wound infections, longer operative times, shorter length of time to return to daily activities, significantly fewer hematomas and seromas with laparoscopic repair. No significant difference in early and overall recurrence rate.