Skip to main content
SpringerLink
Log in

Management of Recurrent Inguinal Hernia at a Tertiary Care Hospital of Southern Sindh, Pakistan

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

The goal of the present study was to determine the frequency, mode of presentation, and need for reoperation in the treatment of recurrent inguinal hernia at Liaquat University Hospital, Jamshoro, Sindh, Pakistan.

Methods

This descriptive, cross-sectional study was conducted over a period of four years, from January 2007 through December 2010. A total of 916 patients with inguinal hernia underwent operation in the Department of Surgery at Liaquat University Hospital Jamshoro, Sindh, Pakistan, during the study period. Of them, 62 patients were diagnosed to have recurrent inguinal hernia and were included in the study. Female patients and patients with other types of hernia like femoral, epigastric, and paraumbilical defects were excluded.

Results

Among the 62 patients studied, the commonest age group with recurrence was 41–50 years (43.5 %). Fifty-one (82.2 %) of the patients were ambulatory workers. In 47 cases (75.8 %) recurrence was on the right side, and in 15 (24.1 %) recurrence was on the left side. First time recurrence was seen in 54 patients (87 %) and second time recurrence was seen in 7 patients (11.2 %); third time recurrence was observed in only one patient. All of these patients had an initial open surgery without mesh, except one. Bassini’s repair was done as a primary repair in 47 (75.8 %) cases. A total of 11 patients (17.7 %) had no previous medical records. Darning repair was done in 3 patients (4.8 %), and open surgery with mesh was performed in only one patient. The highest recurrence rates were seen in patients whose hernia repairs had been done by postgraduate trainees. That is, 45 of the patients requiring reoperation (72.5 %), compared to 11 (17.7 %), and 6 (9.6 %) operations performed by registrars and consultants, respectively. All patients in our study underwent tension-free Lichtenstein mesh repair. Postoperative complications included retention of urine (40.3 %), scrotal hematoma (6.4 %), and wound infection (3.2 %).

Conclusions

Recurrent inguinal hernia is still frequently observed today, and the Lichtenstein tension-free repair has gained great acceptance worldwide and is currently considered the procedure of choice for primary and recurrent inguinal hernias.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Barrat C, Surlin V, Bordea A et al (2003) Management of recurrent inguinal hernias: a prospective study of 163 cases. Hernia 7:125–129

    Article  PubMed  CAS  Google Scholar 

  2. Campanelli G, Pettinari D, Cavalli M et al (2006) Inguinal hernia recurrence: classification and approach. J Minim Access Surg 2:147–150

    Article  PubMed  Google Scholar 

  3. Shulman AG, Amid PK, Lichtenstein IL (1992) Plug repair of recurrent inguinal hernias. Contemp Surg 40:30–33

    Google Scholar 

  4. Gundre NP, Iyer SP, Subramaniyan P (2012) Prospective randomized controlled study using polyethylene mesh for inguinal hernia meshplasty as a safe and cost-effective alternative to polypropylene mesh. Updates Surg 64:37–42

    Article  PubMed  Google Scholar 

  5. Awad SS, Yallampalli S, Srour AM et al (2007) Improved outcomes with the Prolene Hernia System mesh compared with the time-honored Lichtenstein onlay mesh repair for inguinal hernia repair. Am J Surg 193:697–701

    Article  PubMed  Google Scholar 

  6. Takata MC, Duh QY (2008) Laparoscopic inguinal hernia repair. Surg Clin N Am 88:157–178 x

    Article  PubMed  Google Scholar 

  7. EU Hernia Trialists Collaboration (2000) Mesh compared with non-mesh methods of open groin hernia repair: systematic review of randomized controlled trials. Br J Surg 87:854–859

    Article  Google Scholar 

  8. Rutkow IM (2003) Demographic and socioeconomic aspects of hernia repair in the United States in 2003. Surg Clin North Am 83:1045–1051 v–vi

    Article  PubMed  Google Scholar 

  9. Turaga K, Fitzgibbons RJ Jr, Puri V (2008) Inguinal hernias: should we repair? Surg Clin North Am 88:127–138 ix

    Article  PubMed  Google Scholar 

  10. Motson RW (2002) Why does NICE not recommend laparoscopic herniorraphy? BMJ 324(7345):1092–1094

    Article  PubMed  Google Scholar 

  11. Gunnarson U, Heuman R (1999) Patient experience ratings in surgery for recurrent hernia. Hernia 3:69–73

    Article  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  13. Nilsson E (2011) Outcomes. In: Kurzer M, Kark AE, Wantz GE (eds) Surgical management of abdominal wall hernias. Martin Dunitz, London, pp 11–19

  14. Bay-Nilsson E, Kehlet H (1999) Steering committee of the Danish hernia database. Establishment of a national Danish hernia database: preliminary report. Hernia 3:81–83

    Article  Google Scholar 

  15. Ijzermans JN, de Wilt H, Hop WC et al (1991) Recurrent inguinal hernia treated by classical hernioplasty. Arch Surg 126:1097–1100

    Article  PubMed  CAS  Google Scholar 

  16. Millikan KW, Doolas A (2008) A long-term evaluation of the modified mesh-plug hernioplasty in over 2,000 patients. Hernia 12:257–260 discussion 323

    Article  PubMed  CAS  Google Scholar 

  17. Arregui ME, Young SB (2005) Groin hernia repair by laparoscopic techniques: current status and controversies. World J Surg 29:1052–1057. doi:10.1007/s10029-008-0341-9

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  19. Elsebae MM, Nasr M, Said M (2008) Tension-free repair versus Bassini technique for strangulated inguinal hernia: a controlled randomized study. Int J Surg 6:302–305

    Article  PubMed  Google Scholar 

  20. Wara P, Bay-Nielsen M, Juul P et al (2005) Prospective nationwide analysis of laparoscopic versus Lichtenstein repair of inguinal hernia. Br J Surg 92:1277–1281

    Article  PubMed  CAS  Google Scholar 

  21. Solorzano CC, Minter RM, Childers TC et al (1999) Prospective evaluation of the giant prosthetic reinforcement of the visceral sac for recurrent and complex bilateral inguinal hernias. Am J Surg 177:19–22

    Article  PubMed  CAS  Google Scholar 

  22. Lowham AS, Filipi CJ, Fitzgibbons RJ Jr et al (1997) Mechanisms of hernia recurrence after preperitoneal mesh repair. Traditional and laparoscopic. Ann Surg 225:422–431

    Article  PubMed  CAS  Google Scholar 

  23. van der Zwaal P, van den Berg IR, Plaisier PW (2008) Mesh fixation using staples in Lichtenstein’s inguinal hernioplasty: fewer complications and fewer recurrences. Hernia 12:391–394

    Article  PubMed  Google Scholar 

  24. Postlethwait RW (1971) Causes of recurrence after inguinal herniorrhaphy. Surgery 69:772–775

    PubMed  CAS  Google Scholar 

  25. Haapaniemi S, Gunnarsson U, Nordin P et al (2001) Reoperation after recurrent groin hernia repair. Ann Surg 234:122–126

    Article  PubMed  CAS  Google Scholar 

  26. Read RC (1975) Recurrence after preperitoneal herniorrhaphy in the adult. Arch Surg 110:666–671

    Article  PubMed  CAS  Google Scholar 

  27. Gunnarson U, Heuman R (1999) Patient experience ratings in surgery for recurrent hernia. Hernia 3:69–73

    Article  Google Scholar 

  28. Nilsson E, Haapaniemi S, Gruber G et al (1998) Methods of repair and risk for reoperation in Swedish hernia surgery from 1992 to 1996. Br J Surg 85:1686–1691

    Article  PubMed  CAS  Google Scholar 

  29. Feliu PX, Fernández SE (1997) Laparoscopic repair of recurrent inguinal hernia. In: Porrero JL (ed) Cirugía de la pared abdominal [abdominal wall surgery]. Masson, Barcelona, pp 180–187

    Google Scholar 

  30. Felix EL, Michas CA, McKnight RL (1995) Laparoscopic repair of recurrent hernias. Surg Endosc 9:135–138 discussion 138–139

    PubMed  CAS  Google Scholar 

  31. van der Hem JA, Hamming JF, Meeuwis JD et al (2001) Totally extraperitoneal endoscopic repair of recurrent inguinal hernia. Br J Surg 88:884–886

    Article  PubMed  Google Scholar 

  32. Ruhl CE, Everhart JE (2007) Risk factors for inguinal hernia among adults in the US population. Am J Epidemiol 165:1154–1161

    Article  PubMed  Google Scholar 

  33. Barrat C, Surlin V, Bordea A et al (2003) Management of recurrent inguinal hernias: a prospective study of 163 cases. Hernia 7:125–129

    Article  PubMed  CAS  Google Scholar 

  34. Balen EM, Ferr JV, Vicente F et al (2000) Recurrences after prosthetic repair of inguinal hernias by the Lichtenstein technique. Hernia 4:13–16

    Article  Google Scholar 

  35. Vos PM, Simons MP, Luitse JS et al (1998) Follow-up after inguinal hernia repair. Questionnaire compared with physical examination: a prospective study in 299 patients. Eur J Surg 164:533–536

    Article  PubMed  CAS  Google Scholar 

  36. Junge K, Rosch R, Klinge U et al (2006) Risk factors related to recurrence in inguinal hernia repair: a retrospective analysis. Hernia 10:309–315

    Article  PubMed  CAS  Google Scholar 

  37. Sandbichler P, Draxl H, Gstir H et al (1996) Laparoscopic repair of recurrent inguinal hernias. Am J Surg 171:366–368

    Article  PubMed  CAS  Google Scholar 

  38. Morrison JE Jr, Jacobs VR (2008) Laparoscopic preperitoneal inguinal hernia repair using preformed polyester mesh without fixation: prospective study with 1-year follow-up results in a rural setting. Surg Laparosc Endosc Percutan Tech 18:33–39

    Article  PubMed  Google Scholar 

  39. Richards SK, Vipond MN, Earnshaw JJ (2004) Review of the management of recurrent inguinal hernia. Hernia 8:144–148

    Article  PubMed  CAS  Google Scholar 

  40. Harjai MM, Nagpal BM, Singh P et al (2007) A prospective randomized controlled study of Lichtenstein’s tension free versus modified Bassini repair in the management of groin hernias. Med J Armed Forces India 63:40–43

    Article  Google Scholar 

  41. Richards SK, Earnshaw JJ (2003) Management of primary and recurrent inguinal hernia by surgeons from the South West of England. Ann R Coll Surg Engl 85:402–404

    Article  PubMed  CAS  Google Scholar 

  42. Thompson JS, Gibbs JO, Reda DJ et al (2008) Does delaying repair of an asymptomatic hernia have a penalty? Am J Surg 195:89–93

    Article  PubMed  Google Scholar 

  43. Feliu X, Jaurrieta E, Vinas X et al (2004) Recurrent inguinal hernia: a ten-year review. J Laparoendosc Adv Surg Tech A 14:362–367

    PubMed  Google Scholar 

  44. Gianetta E, Cuneo S, Vitale B et al (2000) Anterior tension-free repair of recurrent inguinal hernia under local anesthesia: a 7-year experience in a teaching hospital. Ann Surg 231:132–136

    Article  PubMed  CAS  Google Scholar 

  45. Bringman S, Ramel S, Heikkinen TJ et al (2003) Tension-free inguinal hernia repair: TEP versus mesh-plug versus Lichtenstein: a prospective randomized controlled trial. Ann Surg 237:142–147

    Article  PubMed  Google Scholar 

  46. Eklund A, Rudberg C, Smedberg S et al (2006) Short-term results of a randomized clinical trial comparing Lichtenstein open repair with totally extraperitoneal laparoscopic inguinal hernia repair. Br J Surg 93:1060–1068

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors are grateful to Dr. Jan Muhammad Shaikh, Chairman, Department of Anesthesia, for support in the preoperative management of the patients included in this study. He also contributed by critically analyzing the final draft of the article for any typographical errors and statistical errors. The study was conducted at a public sector hospital that provides state-sponsored treatment. The study was self funded with no external monetary source.

Conflict of interest

The authors declare that they have no competing interests.

Author information

Authors and Affiliations

  1. Department of Surgery, Liaquat University of Medical & Health Sciences, Surgical–Unit 1, Ward 5, Jamshoro, Sindh, 71000, Pakistan

    Ahmer A. Memon, Faisal G. Siddiqui, Arshad H. Abro, Ahmed H. Agha & Abdul S. Memon

  2. Department of Gynecology & Obstetrics, Liaquat University of Medical & Health Sciences, Sindh, 71000, Pakistan

    Shahzadi Lubna

Authors
  1. Ahmer A. Memon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Faisal G. Siddiqui
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Arshad H. Abro
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ahmed H. Agha
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shahzadi Lubna
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Abdul S. Memon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ahmer A. Memon.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Memon, A.A., Siddiqui, F.G., Abro, A.H. et al. Management of Recurrent Inguinal Hernia at a Tertiary Care Hospital of Southern Sindh, Pakistan. World J Surg 37, 510–515 (2013). https://doi.org/10.1007/s00268-012-1897-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-012-1897-1

Keywords

Search

Navigation