Pseudorecurrances After Laparoscopic Inguinal Hernia Repair: Incidence, Predictors and Sequelae

Deborshi Sharma, Priya Hazrah, Raj Kapur, Romesh Lal

Department of Surgery, Lady Hardinge Medical College, New Delhi 110001 India

Introduction: Laparoscopic inguinal hernia repair is an established modality with advantages of fast recovery and lesser post operative pain. Groin or scrotal swelling in post operative period often raises concern in patient’s mind about residual or recurrent disease. Invariably it is due to seroma, haematoma, pneumoscrotum, cord thickening, prolonged cough impulse which are termed as pseudorecurrences. We carried out this study to determine the incidence, predictors and outcome of these variables after laparoscopic inguinal hernia repair.

Methods: All cases done by a single laparoscopic surgeon from August 2007 till July 2012 were retrospectively analyzed. Data from intra and post operative records were analysed for pseudo recurrance and relation of each type of pseudo-recurrance were done with possible predictors like size of hernia, type of hernia, Duration of history of hernia, BMI of patient and type of procedure (TEP/TAPP) undertaken. Univariate analysis and Chi square test done. P-value of ≤0.05 was taken as significant.

Results: Among 243 operated laparoscopic hernias included in the study, there was Seroma-24 (9.87%), Hematoma-18 (7.40%), Pneumoscotum-43 (17.6%), Cord thickening- 8(3.3%) and prolonged cough impulse-6 (2.46%). All were detected by clinical examination, confirmed and diiferentiated by ultra sound examination. Seroma was significantly more in large hernia of ≥5cm (p=0.001), with long standing history (p=0.013) and patients with BMI ≥25 (0.001). However hematoma was more in large (p=0.023) and indirect inguinal hernias (p=0.001). TEP (p=0.001) and indirect hernias (p=0.012) were directly related with increased incidence of Pnemoscrotum. All cases of cord thickening (n=8) were secondary to either seroma or haematoma while persistent cough impulse (n=6) was seen in only direct large hernias. None of the cases in all groups were intervened except one case of seroma.

Conclusion: Pseudo recurrences after laparoscopic inguinal hernia repair can be distressing to patients. Though seen very frequently it has no significant impact on morbidity. Pre-operative risk factors like large, long standing hernias with increased BMI need to be emphasized. Type of hernia and type of procedure performed are risk factors only for prolonged cough impulse and pneumoscrotum respectively. Recognition of the problem is important to continue conservative management and avoid intervention.

Session: Poster Presentation

Program Number: P291

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