Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
Immanuel Hospital Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf, Germany.
Hernia. 2020 Aug;24(4):811-819. doi: 10.1007/s10029-020-02138-1. Epub 2020 Feb 21.
The proportion of recurrent repairs in the total collective of inguinal hernia repairs among men is 11.3-14.3% and among women 7.0-7.4%. The rate of re-recurrences is reported to be 2.9-9.2%. To date, no case series has been published on second and ≥ third recurrences and their treatment outcomes. Only case reports are available.
In an analysis of data from the Herniamed Registry the perioperative and 1-year follow-up outcomes of 16,206 distinct patients who had undergone first recurrent (n = 14,172; 87.4%), second recurrent (n = 1,583; 9.8%) or ≥ third recurrent (n = 451; 2.8%) inguinal hernia repair between September 1, 2009 and July 1, 2017 were compared.
The intraoperative complication rate for all recurrent repairs was between 1-2%. In the postoperative complications a continuous increase was observed (first recurrence: 3.97% vs second recurrence: 5.75% vs ≥ third recurrence 8.65%; p < 0.001). That applied equally to the complication-related reoperation rates (first recurrence: 1.50% vs second recurrence: 2.21% vs ≥ third recurrence 2.66; p = 0.020). Likewise, the re-recurrence rate rose significantly (first recurrence: 1.95% vs second recurrence: 2.72% vs ≥ third recurrence 3.77; p = 0.005). Similarly, the rate of pain requiring treatment rose highly significantly with an increasing number of recurrences (first recurrence: 5.21% vs second recurrence: 6.70% vs ≥ third recurrence 10.86; p = < 0.001).
The repair of re-recurrences in inguinal hernia is associated with increasingly more unfavorable outcomes. For the first recurrence the guidelines should definitely be noted. For a second and ≥ third recurrence diagnostic laparoscopy may help to select the best possible surgical technique.
男性中腹股沟疝修复总病例中复发修复的比例为 11.3-14.3%，女性中为 7.0-7.4%。报告的再复发率为 2.9-9.2%。迄今为止，尚无关于第二和≥第三次复发及其治疗结果的病例系列报告。仅有病例报告。
在对 Herniamed 注册中心数据的分析中，比较了 2009 年 9 月 1 日至 2017 年 7 月 1 日期间接受过首次复发性（n=14172；87.4%）、第二次复发性（n=1583；9.8%）或≥第三次复发性（n=451；2.8%）腹股沟疝修复的 16206 例不同患者的围手术期和 1 年随访结果。
所有复发性修复的术中并发症率在 1-2%之间。在术后并发症中，观察到持续增加（第一次复发：3.97%比第二次复发：5.75%比≥第三次复发：8.65%；p<0.001）。这同样适用于与并发症相关的再次手术率（第一次复发：1.50%比第二次复发：2.21%比≥第三次复发：2.66%；p=0.020）。同样，复发性也显著增加（第一次复发：1.95%比第二次复发：2.72%比≥第三次复发：3.77%；p=0.005）。同样，随着复发次数的增加，需要治疗的疼痛发生率也显著增加（第一次复发：5.21%比第二次复发：6.70%比≥第三次复发：10.86%；p<0.001）。
腹股沟疝的复发性修复与越来越不利的结果相关。对于第一次复发，应明确指南。对于第二次和≥第三次复发，诊断性腹腔镜检查可能有助于选择最佳的手术技术。
