Preliminary assessment of laparoscopic transabdominal pre-peritoneal (TAPP) repair of recurrent inguinal hernia: review of 10 consecutive cases

Manabu Amiki, Masato Yamazaki, Ryota Sakon, Takahiro Inoue, Shun Sato, Mikihisa Nakayama, Masataka Oneyama, Kazuhiro Narita, Ryo Ota, Manabu Goto. Kawasaki Saiwai Hospital

Purpose: We conducted an initial assessment of the efficacy of laparoscopic transabdominal pre-peritoneal (TAPP) repair performed at our hospital in cases of recurrent inguinal hernia.

Methods: We reviewed the cases of 11 patients treated for recurrence of inguinal hernia at our hospital and Saiseikai Kurihashi Hospital between 2012 and 2015, The 11 cases were consecutive and involved 12 hernias (unilateral, n=10; bilateral, n=1). The recurrence was treated by laparoscopic transabdominal pre-peritoneal (TAPP) repair in all 11 patients. We first noted patients’ age and sex and then examined whether the recurrence was related to the type of hernia (direct or indirect). We then looked at outcomes of the TAPP repair in relation to the type of initial surgical repair (conventional or Lichtenstein or Meshplug), time to recurrence, and type of recurrence (direct or indirect), and we investigated whether any complications arose from the TAPP repair, In addition, we looked at TAPP repair time and post-operative hospital stay and compared them with initial repair time and initial post-operative hospital stay.

Results: All patients were men, and they ranged in age at the time of TAPP repair from 53 to 83 years (mean, 75 years). The initial inguinal hernia repairs were performed by the conventional method (n=3) or the Lichtenstein (mesh) method (n=8) or the Meshplug method(n=1). The time to recurrence was about 50 years in the case of conventional repair and 1 to 4 years in the cases of Lichtenstein and Meshplug repair. The recurrences were of the direct type (n=3) or the indirect type (n=9), and they were unrelated to the original hernia types. Median TAPP repair time was 88 minutes (79 to126 minutes) and slightly longer than the initial operation time of 71 minutes (47 to 309 minutes). The same TAPP procedure was used for 12 of the recurrent hernias. In all cases, post-operative hospital stay after the TAPP repair was 3 days, like that following the initial hernia repair. There were no post-TAPP repair complications, and there has been no relapse during the relatively short follow-up period of 15 to 24 months. 

Conclusion: TAPP repair appears to be to be a reliable surgical option for recurrent inguinal hernia.

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