Endoscopic totally extraperitoneal inguinal hernioplasty for recurrence after open repair

Whether endoscopic totally extraperitoneal inguinal hernioplasty (TEP) for recurrent inguinal hernia is as safe and efficacious as that for primary inguinal hernia has rarely been examined. The objective of the present study was to compare the early and late outcomes of TEP for primary and recurrent inguinal hernia. The clinical pattern of recurrence after previous open repair of inguinal hernia was also examined.

Between August 1999 and November 2003, 100 consecutive patients who underwent TEP for recurrent inguinal hernia were recruited. The outcomes of these patients were compared to a randomly selected control group (n = 100) who had TEP for primary inguinal hernia during the same period. All data had been prospectively collected and analysed.

Demographic features were comparable between the two groups. The recurrent group had a significantly higher incidence of direct inguinal hernia than the control group (P < 0.001). Comparison of operative duration, postoperative morbidity, pain score, length of hospital stay and time taken to resume normal activities showed no significant differences between the two groups. However, the incidence of peritoneal tear in the recurrent group (46%) was significantly higher than that of the control group (28%) (P < 0.05). With a mean follow-up of 1 year, the incidences of recurrence and chronic groin pain were similar for both groups.

Early and late outcomes of TEP for recurrent inguinal hernia were equivalent to those for primary inguinal hernia but a higher incidence of peritoneal tear was encountered during TEP for recurrent inguinal hernia. A predominance of direct hernia was observed in the recurrent group.