A Comparison of Outcomes in Open Versus Laparoscopic Surgical Repair of Recurrent Inguinal Hernias

Introduction
Inguinal hernia recurrence following surgical repair is a major concern. There are conflicting views in the surgical community regarding the best treatment approach to prevent recurrence. We report our experience with open and laparoscopic repair of recurrent inguinal hernias.

Methods
After obtaining Institutional Review Board (IRB) approval, we retrospectively reviewed the charts of 98 patients who had surgical repair of recurrent inguinal hernias from January 2004 through July 2009. Repair techniques included open with mesh, transabdominal pre-peritoneal (TAPP), or totally extraperitoneal (TEP). Surgical variables and clinical outcomes were compared using Chi-square, Fisher’s exact, and Mann-Whitney U test.

Results
Ninety-eight patients with a mean age of 55 years underwent either open mesh repair (N=16) or laparoscopic mesh repair (N=82) for recurrent inguinal hernias. Hernia recurrence was found on the right side in 51 patients, left in 41 patients, and bilaterally in 6 patients. The mean operative time was 75 minutes in the open repair and 66 minutes in the laparoscopic (TAPP or TEP) repair (p = 0.15). The mean follow-up was 18.4 months. There were no re-recurrent hernias in the open group and 4 (4.8%) re-recurrent hernias in the laparoscopic group (p=0.5). Two patients (12.5%) in the open group and 10 patients (12.1%) in the laparoscopic group had ongoing pain in the inguinal region (p=0.8). Five patients (31.3%) in the open group and 6 patients (7.3%) in the laparoscopic group had post-operative complications (p=0.02).

Conclusions
Both the open and laparoscopic mesh approaches are acceptable in the treatment of recurrent inguinal hernias. In this retrospective review, there is no statistical difference in the re-recurrence rate between the two techniques. In this study, the complication rate in the open group is greater than in the laparoscopic group. Prospective, randomized multicenter clinical trials are required to determine the ideal approach for the treatment of recurrent inguinal hernias.

Session: Podium Presentation

Program Number: S027