Laparoscopic total extraperitoneal repair of recurrent inguinal hernias

This study aimed to compare the outcome and morbidity parameters of laparoscopic total extraperitoneal (TEP) repair for recurrent and primary inguinal hernias.

A retrospective analysis was conducted over a 3-year period. The recurrence rate; pain scores at 24 h, 1 week, and 4 weeks; hospital stay; days to resumption of normal activities; seroma formation; and urinary retention rates were noted.

Of 937 patients, 52 underwent recurrent and 885 underwent primary hernia repair. The follow-up period was 12 to 40 months (median, 25 months). The mean operating time was longer in the recurrent group (32.7 +/- 6.3 min) than in the primary group (30.1 +/- 6.1 min; p = 0.015). The mean pain scores at 24 h were similar in the two groups (2.28 +/- 0.5 for the recurrent group vs. 2.20 +/- 0.4 for the primary group; nonsignificant difference). However the pain scores at 1 week were significantly higher in the recurrent group (1.35 +/- 0.5) than in the primary group (1.20 +/- 0.4; p = 0.017). The hospital stay (1.19 +/- 0.4 vs. 1.07 +/- 0.3 days; p = 0.002) and the time to resumption of normal activities (8.62 +/- 2.6 vs. 7.67 +/- 1.4 days; p < 0.0001) were significantly longer in the recurrent group than in the primary group. The urinary retention (9.6% vs. 5.4%; nonsignificant difference) and seroma formation (3.8% vs. 3.5%; p = 0.5) were similar in the recurrent and the primary groups, respectively. There were two recurrences and two conversions to open procedure in the primary group and none in the recurrent group.

Laparoscopic TEP repair of recurrent inguinal hernia is safe and effective, with recurrence and conversion rates similar to those for primary hernia repair. However, the operative time, pain at 1 week and 1 month postoperatively, hospital stay, and time to resumption of normal activities with recurrent repair were significantly greater than with laparoscopic primary hernia repair.