Lo Menzo Emanuele, Spector Seth A, Iglesias Alberto, Martinez Jose M, Huaco Jorge, DeGennaro Vincent, Madan Atul K
Miami VA Healthcare System, University of Miami, Miller School of Medicine, 1201 NW 16th Street, Miami, FL 33125, USA.
J Laparoendosc Adv Surg Tech A. 2009 Aug;19(4):475-8. doi: 10.1089/lap.2008.0408.
The laparoscopic repair offers clear advantages in recurrent inguinal hernias after open herniorrhaphy. Less clear is the role of laparoscopy for recurrences after previous laparoscopic inguinal herniorrhaphies. In this paper, we present our experience with both laparoscopic and open inguinal hernia repair of laparoscopic recurrences.
All patients who had undergone repair of recurrences after previous laparoscopic hernia repair from July 2004 to July 2007 were included in this study. Charts were reviewed for all these patients.
Six patients were diagnosed with 7 recurrent inguinal hernias after laparoscopic repairs. All the initial laparoscopic repairs, except for one, were total preperitoneal (TEP) with the placement of lightweight polypropylene mesh. The average time from the initial repair to the diagnosis of recurrence was 20 months (range 3-84). Four of the 7 recurrences were treated with a laparoscopic approach. The other three recurrences were repaired in an open fashion as per the preoperative plan. In 2 of the laparoscopic cases, the peritoneal flap was not able to cover the mesh, so a tissue-separating mesh with fibrin sealant was utilized to cover the myopectineal orifice. No intra- or postoperative complications were recorded. There were no recurrences at an average follow-up of 14 months (range, 11-17).
Laparoscopic repair can be offered to those patients with a recurrence after a previous laparoscopic repair. Further studies comparing laparoscopic repair versus open repair of recurrences after laparoscopic inguinal hernia repair will be helpful in defining the best approach when encountering these recurrences.
腹腔镜修补术在开放疝修补术后复发性腹股沟疝中具有明显优势。而腹腔镜在既往腹腔镜腹股沟疝修补术后复发中的作用尚不太明确。在本文中，我们介绍了腹腔镜和开放手术修补腹腔镜术后复发性腹股沟疝的经验。
纳入2004年7月至2007年7月间所有既往接受过腹腔镜疝修补术后复发并接受修补术的患者。回顾了所有这些患者的病历。
6例患者被诊断为腹腔镜修补术后7例复发性腹股沟疝。除1例之外，所有初次腹腔镜修补术均为完全腹膜前修补术（TEP），并放置了轻质聚丙烯补片。从初次修补到复发诊断的平均时间为20个月（范围3 - 84个月）。7例复发中有4例采用腹腔镜手术治疗。另外3例复发按术前计划采用开放方式修补。在2例腹腔镜手术病例中，腹膜瓣无法覆盖补片，因此使用带纤维蛋白密封剂的组织分离补片覆盖肌耻骨孔。未记录到术中或术后并发症。平均随访14个月（范围11 - 17个月）无复发。
对于既往腹腔镜修补术后复发的患者可采用腹腔镜修补术。进一步比较腹腔镜修补与开放修补腹腔镜腹股沟疝修补术后复发的研究，将有助于确定处理这些复发时的最佳方法。
