Laparoscopic repair of recurrent hernia

BACKGROUND: Failure rates for recurrent hernioplastics vary from 3% to 30%. To help explain this high incidence of recurrence, we reviewed our 4-year experience using a laparoscopic approach and analyzed the characteristics of the recurrent hernias repaired. METHOD: One hundred fifty-two patients with 173 recurrent hernias and 942 patients with 1,230 primary hernias were laparoscopically repaired using either a transabdominal preperitoneal or a totally extraperitoneal laparoscopic approach. RESULTS: With a median follow-up of 24 months, one recurrence developed in the recurrent and four in the primary group. The incidence of bilateral disease (80% versus 46%), and the complexity of the hernias repaired (28% versus 14%) were significantly increased in the recurrent patients. CONCLUSION: The importance of intrinsic weakness and missed hernias as factors that contribute to the failure of recurrent hernioplasties was supported by our findings. The low early failure rate of our laparoscopic approach suggested that this technique may help in eliminating these causes of failure. (C) 1996 by Excerpta Medica, Inc.