Beruflich Dokumente
Kultur Dokumente
Abstract
Introduction: Although laparoscopic totally extraperitoneal hernia repair (TEP) is reported to have a low recurrence rate, few reports address treatment for contralateral occurrence after primary TEP. Most studies on
surgical treatment for recurrent inguinal hernia reported on laparoscopic transabdominal preperitoneal repair.
The aim of this study was to evaluate the efficacy of repeat TEP for contralateral occurrence after primary TEP
for unilateral inguinal hernia.
Methods: We retrospectively reviewed the medical charts of 215 patients undergoing TEP performed between
April 2003 and May 2009. We employed a similar approach to that of standard TEP for primary hernia.
Results: Twenty eight of 215 patients who underwent unilateral TEP also underwent repeat TEP for contralateral-side hernia occurring after primary TEP. The initial hernia was on the right side in 15 patients and on the
left side in 13. The initial hernia was indirect in 26 patients and direct in 2. Mean duration of primary TEP to
contralateral occurrence was 54.4 months. Mean operation time for the contralateral occurrence was 73.3 minutes, and there was little intraoperative blood loss. Three patients were converted to an anterior approach
because of insufficient surgical field due to injury of the peritoneum. Although the inferior epigastric artery and
vein were divided in 4 patients, there were no difficulties during surgery. The postoperative course in all patients
was uneventful.
Conclusions: TEP after primary TEP for contralateral occurrence is feasible. Repeat TEP might be an alternative
technique for new occurrence of contralateral inguinal hernia after primary TEP.
Introduction
repair.811 Although laparoscopic transabdominal preperitoneal repair (TAPP) for recurrence after primary TEP or
TAPP has also proven feasible,8,12,13 only a few studies have
reported on TEP for recurrence after primary TEP. Felix et al.
reported that TEP after primary TEP is virtually impossible.12
Therefore, the purpose of this study was to review our experience with TEP of contralateral hernia recurrence after a
primary TEP.
Patients and Methods
From April 2003 to May 2009, 215 TEPs had been performed for inguinal hernia in Beppu Medical Center. Of
these, 30 TEPs were performed for bilateral inguinal hernia, 157 TEPs for primary inguinal hernia, and 28 TEPs for
Department of Surgery, National Hospital Organization Beppu Medical Center, Beppu, Japan.
Clinical Research Institute, National Hospital Organization Beppu Medical Center, Beppu, Japan.
Department of Gastrointestinal Surgery, Oita University Faculty of Medicine, Yufu, Japan.
2
3
233
234
UCHIDA ET AL.
Table 1. Distribution of Laparoscopic Totally
Extraperitoneal Hernia Repairs
No.
Range
73.3
8.6
3
4
27157
190
No.
Primary TEP
Bilateral
Unilateral
Repeat TEP
187
30
157
28
Total
215
No.
Range
Age (years)
Sex
Male/Female
Type of primary hernia
Right/left
Direct/indirect
Duration of contralateral
occurrence (months)
63.7
2388
26/2
15/13
2/26
54.6
2131
235
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Conclusions
Repeat TEP had no longer operation time and no higher
conversion rate compared with primary TEP. It is thought to
be feasible for contralateral occurrence. Although it has some
difficulty during the dissection of the preperitoneal space,
repeat TEP might be an alternative method for contralateral
occurrence after primary TEP.
Disclosure Statement
No competing financial interests exist.
References
1. Ger R. The management of certain abdominal hernia by
intraabdominal closure of the neck of the sac. Ann R Coll
Surg Engl 1982;64:342344.
2. Berndsen F, Arvidsson D, Enander LK, et al. Postoperative
convalescence after inguinal hernia surgery: Prospective
randomized multicenter study of laparoscopic versus shouldice inguinal hernia repair in 1042 patients. Hernia 2002;6:
5661.
3. Eklund A, Rudberg C, Smedberg S, et al. Short-term results
of a randomized clinical trial comparing Lichtenstein open
14.
15.
16.
17.
Copyright of Journal of Laparoendoscopic & Advanced Surgical Techniques is the property of Mary Ann
Liebert, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the
copyright holder's express written permission. However, users may print, download, or email articles for
individual use.