A unified approach to recurrent laparoscopic hernia repairs

Area of Science:

• Minimally Invasive Surgery
• Abdominal Wall Reconstruction
• Surgical Outcomes Research

Background:

• Recurrence following laparoscopic hernia repair presents a novel challenge with unresolved optimal management strategies.
• The debate continues regarding the preferred approach for recurrent hernias: open, laparoscopic, or combined techniques.

Purpose of the Study:

• To evaluate the safety and success of a laparoscopic approach for managing recurrent hernias after prior laparoscopic repair.

Main Methods:

• Retrospective review of cases performed between July 1991 and September 1999 at the Center for Hernia Repair.
• Analysis of laparoscopic hernioplasties performed for recurrent hernias initially treated laparoscopically.
• All revision repairs were initiated using a transabdominal laparoscopic technique.

Main Results:

• Out of 1960 hernia repairs, 17 were for failed laparoscopic repairs.
• Ten cases were managed entirely laparoscopically, two with an open mesh repair, and five required a small anterior counterincision.
• No severe complications were reported, with only one instance of recurrence.

Conclusions:

• The laparoscopic transabdominal approach is a feasible, safe, and reliable option for treating failed laparoscopic hernia repairs.
• Combining the laparoscopic transabdominal approach with a modified anterior approach, when necessary, enhances treatment efficacy.