Abstract
Background: One of today’s most highly regarded procedures for treating inguinal hernia is the totally extraperitoneal approach (TEP), but it can on occasion lead to recurrence. This is commonly managed with an open repair, a transabdominal preperitoneal procedure (TAPP), or another TEP. We report here on our years of experience with the latter. Methods: The endeavor to a secondary TEP is much the same as to a primary one, but certain differences are encountered as the operation proceeds. For example, many anatomical landmarks found in a first TEP cannot be seen in a second. There can also be a diminished amount of working space, and this occasionally leads to an open conversion. Results: From September 1991 to September 2005, we repaired 1,526 hernias in 1,156 male patients, using the TEP in every case. Of these, 21 were TEPs after a previous TEP. In 3 cases, the space could not be opened, and they were converted to the open Lichtenstein. One patient had peritoneal tears that led to conversion and another had conversion because of excessive bleeding. There were no complications, no bladder or bowel injuries, no transfusions, no preperitoneal hematomas, and no fatalities. All patients were discharged the same day. Conclusions: A secondary TEP, open repair, and TAPP are alternative solutions to the problem of recurrence after TEP. However, any TEP involves a very prolonged learning curve for general surgeons, since they must learn the anatomy as well as the procedure, both at the same time. This is doubly true for the TEP after a previous TEP.
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Amid PK (2005) Groin hernia repair: open techniques. World J Surg 29:1046–1051
Amid PK (2004) Lichtenstein tension-free hernioplasty: its inception, evolution, and principles. Hernia 8:1–7
Arregui ME, Young SB (2005) Groin hernia repair by laparoscopic techniques: current status and controversies. World J Surg 29:1052–1057
Barrat C, Surlin V, Bordea A, Champauld G (2003) Management of recurrent inguinal hernias: a prospective study of 163 cases. Hernia 3:125–129
Chowbey PK, (2003) Recurrent hernia following endoscopic total extraperitoneal repair. J Laparoendosc Adv Tech A 13(1):21–5
Choy C, Shapiro K, Patel S, Graham A, Ferzli G (2004) Investigating a possible cause of mesh migration during totally extraperitoneal (TEP) repair. Surg Endosc 18:523–525
Cook EL, Afzal N, Cornaby AJ (2003) Laparoscopic hernia repairs may make subsequent radical retropubic prostatectomy more hazardous. BJU Int 91:729
Cooperberg MR, Downs IM, Carroll PR (2004) Radical retropubic prostatectomy frustrated by prior laparoscopic mesh herniorrhaphy. Surgery 135:452–453
Davis CJ, Arregui ME (2003) Laparoscopic repair for groin hernias. Surg Clin N Am 83:1141–1161
DeTurris SV, Cacchione RN, Mungara A, Pecoraro AM, Ferzli GS (2002) Laparoscopic herniorrhaphy: beyond the learning curve. J Am Coll Surg 194(1):65–73
Feliu X, Jaurrieta E, Vinas X, Macarulla E, Abad JM, Fernandez-Sallent E (2005) Recurrent inguinal hernia: a ten-year review. Hernia 9(2):120–124
Felix E, Scott S, Crafton B, Geis P, Duncan T, Sewell R, McKernan B (1998) Causes of recurrence after laparoscopic hernioplasty: a multicenter study. Surg Endosc 12:226–231
Ferzli GS, Massad A, Albert P (1992) Extraperitoneal endoscopic inguinal hernia repair. J Laparoendosc Surg 2(6):281–286
Ferzli GS, Kiel T (1995) Evolving techniques in endoscopic extraperitoneal herniorrhaphy. Surg Endosc 9(8):928–930
Ferzli GS, Shapiro K, DeTurris SV, Sayad P, Patel S, Graham A, Chaudry G (2004) Totally extraperitoneal (TEP) hernia repair after an original TEP. Is it safe, and is it even possible? Surg Endosc 18(3):526–528
Ferzli GS (1996) Extraperitoneal herniorrhaphy. In: Lanzafame RJ (ed) Prevention and management of complications in minimally invasive surgery. Igaku-Shoin, New York, pp 139–154
Grunwaldt LJ, Schwaitzberg SD, Rattner D, Jones D (2005) Is laparoscopic inguinal hernia repair an operation of the past? J Am Coll Surg 200(4):616–620
Kaafarani H, Itani K, Giobbie-Hurder A, Gleysteen JJ, McCarthy M Jr, Gibbs J, Neumayer L (2005) Does surgeon frustration and satisfaction with the operation predict outcomes of open or laparoscopic inguinal hernia repair? J Am Coll Surg 200(5):677–683
Katz EE, Patel RV, Sokoloff MH, Vargish T, Brendler CB (2002) Bilateral laparoscopic inguinal hernia repair can complicate subsequent radical retropubic prostatectomy. J Urol 167:637–638
Knook MTT, Weidema WF, Stassen LPS, van Steensel CJ (1999) Laparoscopic repair of recurrent inguinal hernias after endoscopic herniorrhaphy. Surg Endosc 13:1145–1147
Lau H (2004) Endoscopic totally extraperitoneal inguinal hernioplasty for recurrence after open repair. J Laparoendosc Adv Surg Tech 14(2):93–96
Lau WY (2002) History of treatment of groin hernia. World J Surg 26:748–759
Leibl BJ, Schmedt CG, Kraft K, Ulrich M, Bittner R (2000) Recurrence after endoscopic transperitoneal hernia repair (TAPP): causes, reparative techniques and results of the reoperation. J Am Coll Surg 190:651–655
Liem MS, van Duyn E, van der Graaf Y, van Vroonhoven T (2003) Recurrences after conventional anterior and laparoscopic inguinal hernia repair. A randomized comparison. Ann Surg 237:135–141
Neumayer L, Giobbie-Hurder A, Jonasson O, Fitzgibbons R Jr, Dulop D, Gibbs J, Reda D, Henderson W (2004) Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 350(18):1819–1827
Papaoramidou MS, Chirstopoulou-Aletras H (2005) Treatment of hernia in the writings of Celsus (first century AD). World J Surg 29:1343–1347
Paterson H, Casey J, Nixon S (2005) Total extraperitoneal laparoscopic hernia repair in patients with previous lower abdominal surgery. J Laparoendosc Adv Surg 15(2):121–124
Pawanindra L, Kajla RK, Chander J et al (2004) Laparoscopic total extraperitoneal (TEP) inguinal hernia repair. Overcoming the learning curve. Surg Endosc 18:642–645
Richards SK, Vipond MN, Earnshaw JJ (2004) Review of the management of recurrent inguinal hernia. Hernia (8) 144–148
Scheuerlein H, Schiller A, Schneider C, Scheidbach H, Tamme C, Konckerling F (2003) Total extraperitoneal repair of recurrent inguinal hernia results with 179 consecutive patients. Surg Endosc 17:1072–1076
Stolzenburg JU, Anderson C, Rabenalt R, Do M, Ho K, Truss MC (2005) Endoscopic extraperitoneal radical prostatectomy in patients with prostate cancer and previous laparoscopic inguinal mesh placement for hernia repair. World J Urol 27:1–5
Stolzenburg J, Ho KMT, Do M, Rabenalt R, Dorschner W, Truss M (2005) Impact of previous surgery on endoscopic extraperitoneal radical prostatectomy. Urology 65:325–331
Stoppa R, Warlaumont CR (1989) The preperitoneal approach and prosthetic repair of groin hernia. In: Nyhus LM, Condon R (eds) Hernia. Lippincott, Philadelphia, pp 1898–225
Stoppa RE (1995) The preperitoneal approach and prosthetic repair of groin hernias. In: Nyhus LM, Condon R (eds) Hernia. Lippincott, Philadelphia, pp 188–206
Tamme C, Scheidbach H, Hampe C, Schneider C, Kockerling F (2003) Totally extraperitoneal endoscopic inguinal hernia repair (TEP). Surg Endosc 17:190–195
Wantz GE (1995) Personal experience with the Stoppa technique. In: Nyhus LM, Condon R (eds) Hernia. Lippincott, Philadelphia, pp 206–210
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Ferzli, G.S., Khoury, G.E. Treating recurrence after a totally extraperitoneal approach . Hernia 10, 341–346 (2006). https://doi.org/10.1007/s10029-006-0106-2
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DOI: https://doi.org/10.1007/s10029-006-0106-2