Recurrences

Hernia recurrence remains the most reported and widely scrutinized aspect of hernior-rhaphy. There are numerous causes of recurrences during laparoscopic hernia repair, with the majority being technical failures (Table 4).

The most common causes of hernia recurrence are incomplete dissection and inadequate size of the mesh coverage (12,13).

When performing a laparoscopic hernia repairs, it is imperative that all potential defect sites as well as cord lipomas be investigated. Failure to identify and remove a cord lipoma may let the patient believe a hernia still exists (14). A large piece of mesh is required to cover all potential sites including the direct, indirect, and femoral space.

Numerous studies have demonstrated that at least 2 to 3 cm of defect overlap is required, as well as the size of prosthesis being greater than 10 X 14 cm to prevent this type of failure (9,11,15).

Other causes of recurrences include mesh migration, shrinkage, and poor fixation (10). Fixation of the mesh is currently debatable. Two studies have shown no difference in recurrence rates when a large piece of mesh is used to cover the defect without fixation tacks (9,16). The most important finding in both studies is that a large piece of mesh was required for the repair.

TABLE4 ■ Causes of Recurrences TABLE5 ■ Recurrence Rates of Laparoscopic Herniorrhaphy

Learning curve

incomplete

Missed hernia

dissection:

Missed lipoma

Inadequate reduction of sac

Mesh:

Inadequate size of mesh

Inadequate overlap of defect

Poor fixation

Mesh displacement:

Hematoma

Seroma

Migration

Rolling of mesh

Shrinkage

TABLE4 ■ Causes of Recurrences TABLE5 ■ Recurrence Rates of Laparoscopic Herniorrhaphy

Follow-up

Recurrence rates

Study

Technique

No. of repairs

(mo)

(%)

Aeberhard et al. (Surg Endosc)

TEP

16G5

12

1.3

Felix et al. (Surg Endosc)

TAPP/TEP

1423

42

G.4

Frankum et al. (Am Surg)

TEP

779

3G

G.2

Knook et al. (Surg End)

TEP

256

4G

5

O'Dwyer et al. (Lancet)

TEP/TAPP

468

12

1.9

Sayed et al. (Surg Endosc)

TAPP

536

17

G.6

Abbreviations: TAPR transabdominal preperitoneal repair; TER totally extraperitoneal.

Abbreviations: TAPR transabdominal preperitoneal repair; TER totally extraperitoneal.

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