Preperitoneal repair (open posterior approach) for recurrent inguinal hernias previously treated with Lichtenstein tension-free hernioplasty

Abstract

Background: The repair of recurrent inguinal hernias after prosthetic mesh repair is usually diffucult due to considerable technical challenge and complications. There is also a greater risk of developing further recurrence. The aim of this study was to investigate the outcome of preperitoneal repair (open posterior approach) for recurrent inguinal hernias after Lichtenstein tension-free hernioplasty.

Methods: We performed a prospective clinical study in 44 patients having recurrent inguinal hernias the period 2002- 2008. Preperitoneal repair was performed on all patients who have had Lichtenstein tension-free hernioplasty previously. The age, gender, operating time, hospital stay, postoperative complication rates and recurrence rates of patients were evaluated.

Results: There were no serious intraoperative complications. There were 36 men and 9 women in the study, whose average age was 38.45 (25-68) years. The average operative time and hospital stay were 44.56 (30-120) min and 1.6 (1-3) days, respectively. Complications included 4.5 % seromas, 4.5 % hematomas and urinary retention in 9.09 % patients. Follow-up to date is 1-90 months (range, median 40 months).

Conclusions: We concluded that the preperitoneal repair (open posterior approach) in recurrent inguinal hernias after Lichtenstein tension-free hernioplasty is a safe and efficient method with low complication and rerecurrence rates.

Keywords: Lichtenstein tension free hernioplasty; anterior approach; mesh repair; open posterior approach; preperitoneal repair; recurrent inguinal hernia.

Figure 1. A) Preoperative view, long black arrow shows preperitoneal incision, short arrow shows previous lihtenstein incision. B) Dissection of the preperitoneal virgin area, long arrow shows posterior view of the cooper line. C) Posterior mesh placement, black arrow shows cord stracture.