Ann Surg Treat Res.  2024 Jun;106(6):330-336. 10.4174/astr.2024.106.6.330.

Comparative analysis of different surgical approaches for recurrent inguinal hernia: a single-center observational study

• Choi MJ
• Lee KS
• Oh HK
• Ahn SH
• Ahn Hm
• Shin HR
• Lee TG
• Jo MH
• Kim DW
• Kang SB

• KMID: 2556324
• DOI: http://doi.org/10.4174/astr.2024.106.6.330

Abstract

Purpose
Managing recurrent inguinal hernias is complex, and choosing the right surgical approach (laparoscopic vs. open) is vital for patient outcomes. This study compared the outcomes of using the same vs. different surgical approaches for initial and subsequent hernia repairs.
Methods
We retrospectively analyzed patients who underwent recurrent inguinal hernia repair at Seoul National University Bundang Hospital between January 2014 and May 2023. Patients were divided into the “concordant” and “discordant” groups, comprising patients who underwent same and different approaches in both surgeries, respectively. Preoperative baseline characteristics, index surgery data, postoperative outcomes, and recurrence rates were analyzed and compared.
Results
In total, 131 patients were enrolled; the concordant and discordant groups comprised 31 (open, n = 19; laparoscopic, n = 12) and 100 patients (open to laparoscopic, n = 68; laparoscopic to open, n = 32), respectively. No significant differences were observed in the mean operation time (50.5 ± 21.7 minutes vs. 50.2 ± 20.0 minutes, P = 0.979), complication rates (6.5% vs. 14.0%, P = 0.356), or 36-month cumulative recurrence rates (9.8% vs. 9.8%; P = 0.865). The mean postoperative hospital stay was significantly shorter in the discordant than in the concordant group (1.8 ± 0.7 vs. 1.4 ± 0.6, P = 0.003).
Conclusion
Most recurrent inguinal hernia repairs were performed using the discordant surgical approach. Overall, concordance in the surgical approach did not significantly affect postoperative outcomes. Therefore, the selection of the surgical approach based on the patient’s condition and surgeon’s preference may be advisable.

Keyword

Hernia; Herniorrhaphy; Inguinal hernia; Laparoscopy; Minimally invasive surgical procedures

Figure

• 

  Fig. 1 Trends in surgical approach for recurrent inguinal hernia repair at our center in the last decade.

• 

  Fig. 2 Comparison of the 36-month cumulative re-recurrence rate in patients treated at our center.

Reference

1. Murphy BL, Ubl DS, Zhang J, Habermann EB, Farley DR, Paley K. Trends of inguinal hernia repairs performed for recurrence in the United States. Surgery. 2018; 163:343–350. PMID: 28923698.

2. Kingsnorth A, LeBlanc K. Hernias: inguinal and incisional. Lancet. 2003; 362:1561–1571. PMID: 14615114.

3. Shah NR, Mikami DJ, Cook C, Manilchuk A, Hodges C, Memark VR, et al. A comparison of outcomes between open and laparoscopic surgical repair of recurrent inguinal hernias. Surg Endosc. 2011; 25:2330–2337. PMID: 21298523.

4. Sgourakis G, Dedemadi G, Gockel I, Schmidtmann I, Lanitis S, Zaphiriadou P, et al. Laparoscopic totally extraperitoneal versus open preperitoneal mesh repair for inguinal hernia recurrence: a decision analysis based on net health benefits. Surg Endosc. 2013; 27:2526–2541. PMID: 23344511.

5. Köckerling F, Krüger C, Gagarkin I, Kuthe A, Adolf D, Stechemesser B, et al. What is the outcome of re-recurrent vs recurrent inguinal hernia repairs?: an analysis of 16,206 patients from the Herniamed Registry. Hernia. 2020; 24:811–819. PMID: 32086633.

6. Hawasli A, Thao U, Chapital A. Laparoscopic transabdominal preperitoneal inguinal hernia repair for recurrent inguinal hernia. Am Surg. 2002; 68:303–308. PMID: 11894858.

7. Kurzer M, Belsham PA, Kark AE. Prospective study of open preperitoneal mesh repair for recurrent inguinal hernia. Br J Surg. 2002; 89:90–93. PMID: 11851671.

8. Scheuerlein H, Schiller A, Schneider C, Scheidbach H, Tamme C, Köckerling F. Totally extraperitoneal repair of recurrent inguinal hernia. Surg Endosc. 2003; 17:1072–1076. PMID: 12728379.

9. Beltrán MA, Cruces KS. Outcomes of Lichtenstein hernioplasty for primary and recurrent inguinal hernia. World J Surg. 2006; 30:2281–2289. PMID: 17086374.

10. Goo TT, Lawenko M, Cheah WK, Tan C, Lomanto D. Endoscopic total extraperitoneal repair of recurrent inguinal hernia: a 5-year review. Hernia. 2010; 14:477–480. PMID: 20495842.

11. Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009; 13:343–403. PMID: 19636493.

12. 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. 2017; 31:3168–3185. PMID: 27933397.

13. Stabilini C, van Veenendaal N, Aasvang E, Agresta F, Aufenacker T, Berrevoet F, et al. Update of the international HerniaSurge guidelines for groin hernia management. BJS Open. 2023; 7:zrad080. PMID: 37862616.

14. Karthikesalingam A, Markar SR, Holt PJ, Praseedom RK. Meta-analysis of randomized controlled trials comparing laparoscopic with open mesh repair of recurrent inguinal hernia. Br J Surg. 2010; 97:4–11. PMID: 20013926.

15. Pisanu A, Podda M, Saba A, Porceddu G, Uccheddu A. Meta-analysis and review of prospective randomized trials comparing laparoscopic and Lichtenstein techniques in recurrent inguinal hernia repair. Hernia. 2015; 19:355–366. PMID: 25033943.

16. Li J, Ji Z, Li Y. Comparison of laparoscopic versus open procedure in the treatment of recurrent inguinal hernia: a meta-analysis of the results. Am J Surg. 2014; 207:602–612. PMID: 24139670.

17. Morales-Conde S, Socas M, Fingerhut A. Endoscopic surgeons’ preferences for inguinal hernia repair: TEP, TAPP, or OPEN. Surg Endosc. 2012; 26:2639–2643. PMID: 22437960.

18. Shenoy KG, Makam R. Feasibility and safety of redo laparoscopic repair of recurrent inguinal hernia following previous endolaparoscopic repair. J Minim Access Surg. 2024; 20:67–73. PMID: 37843165.

19. van den Heuvel B, Dwars BJ. Repeated laparoscopic treatment of recurrent inguinal hernias after previous posterior repair. Surg Endosc. 2013; 27:795–800. PMID: 23052496.

20. Velasco JM, Gelman C, Vallina VL. Preperitoneal bilateral inguinal herniorrhaphy evolution of a technique from conventional to laparoscopic. Surg Endosc. 1996; 10:122–127. PMID: 8932612.

21. Madion M, Goldblatt MI, Gould JC, Higgins RM. Ten-year trends in minimally invasive hernia repair: a NSQIP database review. Surg Endosc. 2021; 35:7200–7208. PMID: 33398576.