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. 2017 May 1:4:22.
doi: 10.3389/fsurg.2017.00022. eCollection 2017.

Diagnostic Laparoscopy as Decision Tool for Re-recurrent Inguinal Hernia Treatment Following Open Anterior and Laparo-Endoscopic Posterior Repair

Ferdinand Köckerling  1 , Christine Schug-Pass  1
Affiliations

Diagnostic Laparoscopy as Decision Tool for Re-recurrent Inguinal Hernia Treatment Following Open Anterior and Laparo-Endoscopic Posterior Repair

Ferdinand Köckerling et al. Front Surg. .

Abstract

Introduction: The guidelines of the international hernia societies recommend posterior repair in laparo-endoscopic technique for recurrent inguinal hernia after open anterior mesh repair and, conversely, open anterior repair for recurrence after laparo-endoscopic primary repair. Even when these guidelines are followed, already 1 year after repair a re-recurrence rate of 1-2% must be expected, with that rate rising further in the subsequent years. Accordingly, increasingly more patients with re-recurrence after anterior and posterior mesh implantation must be treated, which constitutes a problem that to date has been investigated in only very few studies. Hence, there are no well-founded recommendations. This paper now presents a number of case reports aimed at identifying the role of explorative laparoscopy as decision tool for re-recurrent inguinal hernia treatment.

Patients and methods: Based on three case reports the role of explorative laparoscopy as decision tool for re-recurrent inguinal hernia treatment is presented below.

Results: In all the three cases described explorative laparoscopy played a key role as decision tool when deciding how best to treat re-recurrence after anterior and posterior inguinal hernia repair. In one case severe adhesions after robotic prostatectomy and in another case correct placement of the mesh in the posterior plane, adhesions from the cecum to the groin region and no definitive finding of a re-recurrence resulted in an open repair. In the third case, an insufficient laparoscopic posterior mesh placement made the re-recurrent TAPP procedure relatively easy.

Conclusion: Explorative laparoscopy is an important decision tool for re-recurrent inguinal hernia treatment to minimize the risks of the procedure for the patients.

Keywords: TAPP; explorative laparoscopy; guidelines; inguinal hernia; re-recurrence.

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Figures

Figure 1
Figure 1
Explorative laparoscopy of the left groin for re-recurrence following TAPP and Lichtenstein operation.
Figure 2
Figure 2
Good visualization of the medial re-recurrence following TAPP and Lichtenstein operation (left groin).
Figure 3
Figure 3
Following incision of the peritoneum above and below the incorrectly positioned mesh, dissection of the left groin.
Figure 4
Figure 4
Placement of a mesh measuring 10 cm × 15 cm (TiMesh light, pfm medical, Cologne) and fixation of the superior margin with absorbable tackers (SecureStrap, Ethicon, Norderstedt) (left groin).
Figure 5
Figure 5
Placement of a drain between the abdominal wall and peritoneum and closure of the peritoneal defect with a continuous suture (left groin).
Figure 6
Figure 6
Explorative laparoscopy of the left groin for re-recurrence following TAPP and Lichtenstein operation as well as robotic radical prostatectomy.
Figure 7
Figure 7
Repair of medial re-recurrence after TAPP and Lichtenstein operation with a plug (left groin).
Figure 8
Figure 8
Explorative laparoscopy for re-recurrence after TAPP and Shouldice operation (right groin).
Figure 9
Figure 9
Extensive lipoma and additional hernia sac identified during open re-recurrent operation (right groin).
Figure 10
Figure 10
Closure of the lateral re-recurrent hernia in Lichtenstein technique (right groin).
Figure 11
Figure 11
Diagnostic and therapeutic algorithm in re-recurrent inguinal hernias after anterior and posterior primary and recurrent repair.
See this image and copyright information in PMC

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References

    1. Köckerling F, Jacob D, Wiegank W, Hukauf M, Schug-Pass C, Kuthe A, et al. Endoscopic repair of primary versus recurrent male unilateral inguinal hernias: are there differences in the outcome? Surg Endosc (2016) 30:1146–55.10.1007/s00464-015-4318-3 - DOI - PMC - PubMed
    1. Köckerling F, Koch A, Lorenz R, Reinpold W, Hukauf M, Schug-Pass C. Open repair of primary versus recurrent male unilateral inguinals hernias: perioperative complications and 1-year-follow-up. World J Surg (2016) 40:813–25.10.1007/s00268-015-3325-9 - DOI - PMC - PubMed
    1. Köckerling F, Koch A, Lorenz R, Schug-Pass C, Stechemesser B, Reinpold W. How long do we need to follow-up our hernia patients to find the real recurrence rate? Front Surg (2015) 2:24.10.3389/fsurg.2015.00024 - DOI - PMC - PubMed
    1. Köckerling F, Bittner R, Kuthe A, Stechemesser B, Lorenz R, Koch A, et al. Laparo-endoscopic versus open recurrent inguinal hernia repair: should we follow the guidelines? Surg Endosc (2016).10.1007/s00464-016-5342-7 - DOI - PMC - PubMed
    1. Bisgaard T, Bay-Nielsen M, Kehlet H. Re-recurrence after operation for recurrent inguinal hernia. A nationwide 8-year follow-up study on the role of type of repair. Ann Surg (2008) 247(4):707–11.10.1097/SLA.0b013e31816b18e3 - DOI - PubMed

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