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.
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HerniaSurge Group (2018) International guidelines for groin hernia management. Hernia 22:1–165. https://doi.org/10.1007/s10029-017-1668-x
Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M (2009) European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 13:343–403. https://doi.org/10.1007/s10029-009-0529-7
Rosenberg J, Bisgaard T, Kehlet H, Wara P, Asmussen T, Juul P, Strand L, Andersen FH, Bay-Nielsen M (2011) Danish Hernia Database recommendations for the management of inguinal and femoral hernia in adults. Dan Med Bull 58:C4243
Oberg S, Andresen K, Rosenberg J (2016) Surgical approach for recurrent inguinal hernias: a Nationwide Cohort Study. Hernia 20:777–782. https://doi.org/10.1007/s10029-016-1531-5
Sevonius D, Montgomery A, Smedberg S, Sandblom G (2016) Chronic groin pain, discomfort and physical disability after recurrent groin hernia repair: impact of anterior and posterior mesh repair. Hernia 20:43–53. https://doi.org/10.1007/s10029-015-1439-5
Öberg S, Andresen K, Nilsson H, Angenete E, Rosenberg J (2019) Chronic pain after two laparoendoscopic inguinal hernia repairs compared with laparoendoscopic repair followed by the Lichtenstein repair: an international questionnaire study. Surg Endosc. https://doi.org/10.1007/s00464-019-06853-4(In press)
Öberg S, Andresen K, Baker JJ, Angenete E, Rosenberg J (2019) Chronic pain after reoperation of an inguinal hernia with Lichtenstein or laparoscopic repair following a primary Lichtenstein repair: a nationwide questionnaire study. Am J Surg. https://doi.org/10.1016/j.amjsurg.2019.04.015(In press)
Sevonius D, Sandblom G, Agger E, Smedberg S, Montgomery A (2015) The impact of type of mesh repair on 2nd recurrence after recurrent groin hernia surgery. World J Surg 39:315–322. https://doi.org/10.1007/s00268-014-2921-4(Discussion 23–24)
Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, Poole C, Schlesselman JJ, Egger M (2014) Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. Int J Surg 12:1500–1524. https://doi.org/10.1016/j.ijsu.2014.07.014
Friis-Andersen H, Bisgaard T (2016) The Danish Inguinal Hernia database. Clin Epidemiol 8:521–524
Amid PK, Shulman AG, Lichtenstein IL (1993) Critical scrutiny of the open "tension-free" hernioplasty. Am J Surg 165:369–371
Amid PK (2004) Lichtenstein tension-free hernioplasty: its inception, evolution, and principles. Hernia 8:1–7
Litwin DE, Pham QN, Oleniuk FH, Kluftinger AM, Rossi L (1997) Laparoscopic groin hernia surgery: the TAPP procedure. Transabdominal preperitoneal hernia repair. Can J Surg 40:192–198
Sarli L, Pietra N, Choua O, Costi R, Cattaneo G (1997) Laparoscopic hernia repair: a prospective comparison of TAPP and IPOM techniques. Surg Laparosc Endosc 7:472–476
Kumar S (2004) Open mesh versus laparoscopic mesh hernia repair. N Engl J Med 351:1463–1465 (Author reply 1463–5)
Miserez M, Alexandre JH, Campanelli G, Corcione F, Cuccurullo D, Pascual MH, Hoeferlin A, Kingsnorth AN, Mandala V, Palot JP, Schumpelick V, Simmermacher RK, Stoppa R, Flament JB (2007) The European hernia society groin hernia classification: simple and easy to remember. Hernia 11:113–116. https://doi.org/10.1007/s10029-007-0198-3
Öberg S, Andresen K, Rosenberg J (2017) Etiology of inguinal hernias: a comprehensive review. Front Surg 22(4):52. https://doi.org/10.3389/fsurg.2017.00052
Beitler JC, Gomes SM, Coelho AC, Manso JE (2009) Complex inguinal hernia repairs. Hernia 13:61–66. https://doi.org/10.1007/s10029-008-0432-7
Novaretti JP, Silva RD, Cotrim CA, Souto LR (2012) Migration mesh mimicking bladder malignancy after open inguinal hernia repair. Hernia 16:467–470. https://doi.org/10.1007/s10029-010-0760-2
Felix EL (2001) A unified approach to recurrent laparoscopic hernia repairs. Surg Endosc 15:969–971
Bittner R, Arregui ME, Bisgaard T et al (2011) Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia [International Endohernia Society (IEHS)]. Surg Endosc 25:2773–2843. https://doi.org/10.1007/s00464-011-1799-6
Bittner R, Montgomery MA, Arregui E et al (2015) Update of guidelines on laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia (International Endohernia Society). Surg Endosc 29:289–321. https://doi.org/10.1007/s00464-014-3917-8
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196. https://doi.org/10.1097/SLA.0b013e3181b13ca2
This study received no financial support from extramural sources.
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Öberg reports no potential conflicts of interest. Jessen reports no potential conflicts of interest. Andresen reports no potential conflicts of interest. Rosenberg reports personal fees from MSD, outside the submitted work.
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Öberg, S., Jessen, M.L., Andresen, K. et al. Technical details and findings during a second Lichtenstein repair or a second laparoscopic repair in the same groin: a study based on medical records. Hernia 25, 149–157 (2021). https://doi.org/10.1007/s10029-019-02090-9
- Tailored repair
- Lichtenstein reoperation
- TAPP reoperation