Technical details and findings during a second Lichtenstein repair or a second laparoscopic repair in the same groin:...

There are cases where surgeons repair a recurrent inguinal hernia using a second Lichtenstein repair (Lichtenstein-Lichtenstein) or a second laparoscopic repair (Laparoscopy-Laparoscopy) in the same groin even though this contradicts current guideline recommendations. The aim of this study was to provide an overview of surgical modifications and findings during these reoperations.

Patients in this observational study were identified in the nationwide Danish Hernia Database during a 6-year period. Outcomes were identified in medical records. The primary outcome was the prevalence of tailored reoperations and standard reoperations for Lichtenstein-Lichtenstein and Laparoscopy-Laparoscopy, respectively. The secondary outcomes were findings during the reoperation such as inguinal hernia type and size, fibrosis, and difficulty to identify anatomical landmarks.

Of the 102 Lichtenstein reoperations, 43 (42%) were tailored repairs and 59 (58%) were standard repairs. The most common modifications were posterior wall reinforcement with permanent sutures, dividing a structure to enable sufficient hernioplasty, and a modification of the new mesh size and/or shape. There were no differences in the findings during tailored- and standard Lichtenstein reoperations. Of the 58 laparoscopic reoperations, 35 (60%) were tailored repairs and 23 (40%) were standard repairs. The most common modifications were necessitation of a coated mesh due to insufficient peritoneal coverage and use of unusual mesh sizes and/or shapes. Fibrosis was more commonly described during the tailored laparoscopic reoperations.

A substantial part of the Lichtenstein- and the laparoscopic reoperations was tailored approaches, and various modifications were used. Fibrosis was more commonly described during tailored laparoscopic reoperations.