Causes of recurrence in laparoscopic inguinal hernia repair

The analysis of possible mechanisms of repair failure is a necessary instrument and the best way to decrease the recurrence rate and improve the overall results. Avoiding historical errors and learning from the reported pitfalls and mistakes helps to standardize the relatively new laparoscopic techniques of trans-abdominal preperitoneal and total extraperitoneal.

The video tapes of all primary laparoscopic repairs done by the author that led to recurrence were retrospectively analyzed and compared with findings at the second laparoscopic repair. A review of the available cases of recurrences occurring between 1994 and 2003 is the basis of this report.

Adequate mesh size, porosity of mesh material, slitting of the mesh, correct and generous dissection of preperitoneal space and wrinkle-free placement of the mesh seem to be the more important factors in avoiding recurrence rather than strength of the material or strong penetrating fixation. Special attention should be paid to preperitoneal lipoma as a possible overlooked herniation or potential future pseudorecurrence despite nondislocated correctly positioned mesh.

Laparoscopic hernia repair is a complex but very efficient method in experienced hands. To achieve the best possible results, it requires an acceptance of a longer learning curve, structured well-mentored training and high level of standardization of the operative procedure.