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Published in: BMC Surgery 1/2012

Open Access 01-12-2012 | Research article

Open preperitoneal versus anterior approach for recurrent inguinal hernia: a randomized study

Authors: Aly Saber, Goda M Ellabban, Mohammad A Gad, Karam Elsayem

Published in: BMC Surgery | Issue 1/2012

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Abstract

Background

Inguinal herniorrhaphy remains one of the most common general surgical operations, with approximately 15% performed for recurrence. The repair of the resulting recurrent hernia is a daunting task because of already weakened tissues and obscured and distorted anatomy. The aim of this study is to compare the posterior preperitoneal versus anterior tension-free approach for repair of unilateral recurrent inguinal hernia regarding complications and early recurrence.

Methods

120 Patients in this study were divided randomly into 2 main groups; Group A patients were subjected to posterior preperitoneal approach and those of group B were subjected to conventional anterior tension-free repair. The primary end point was recurrence and the secondary end points were time off from work, postoperative pain, scrotal swelling and wound infections.

Results

The mean hospital stay was 1.2 days and 4.7, the mean time to return work was 8.2 and 11.2 days and the mean time off from work was 9.4 and 15.9 days in group A and B respectively. The maximum follow-up period was 48 months and the minimum was 14 months with a mean value as 37.11 ± 5.14 months. Only 2 recurrences (3.3%) in group A and 4 cases (6.25%) in group B were seen. The final pain score per patient and the overall complication rate were higher in group B.

Conclusions

The open preperitoneal repair offers the advantages of low recurrence rate and allows covering all potential defects with one piece of mesh and is far superior to the anterior approach.

Trial Registration

ACTRN12611000337976
Appendix
Available only for authorised users
Literature
1.
go back to reference Rosenberg J, Bisgaard T, Kehlet H, Wara P, Asmussen T, Juul P, Strand L, Andersen FH, Bay-Nielsen M: Danish HerniaDatabase. Danish Hernia Database recommendations for the management of inguinal and femoral hernia in adults. Dan Med Bull. 2011, 58 (2): C4243-PubMed Rosenberg J, Bisgaard T, Kehlet H, Wara P, Asmussen T, Juul P, Strand L, Andersen FH, Bay-Nielsen M: Danish HerniaDatabase. Danish Hernia Database recommendations for the management of inguinal and femoral hernia in adults. Dan Med Bull. 2011, 58 (2): C4243-PubMed
2.
go back to reference Bisgaard T, Bay-Nielsen M, Kehlet H: Re-recurrence after operation for recurrent inguinal hernia. A nationwide 8-year follow-up study on therole of type of repair. Ann Surg. 2008, 247 (4): 707-711. 10.1097/SLA.0b013e31816b18e3.CrossRefPubMed Bisgaard T, Bay-Nielsen M, Kehlet H: Re-recurrence after operation for recurrent inguinal hernia. A nationwide 8-year follow-up study on therole of type of repair. Ann Surg. 2008, 247 (4): 707-711. 10.1097/SLA.0b013e31816b18e3.CrossRefPubMed
3.
go back to reference Richards SK, Vipond MN, Earnshaw JJ: Review of the management of recurrent inguinal hernia. Hernia. 2004, 8 (2): 144-148. 10.1007/s10029-003-0194-1.CrossRefPubMed Richards SK, Vipond MN, Earnshaw JJ: Review of the management of recurrent inguinal hernia. Hernia. 2004, 8 (2): 144-148. 10.1007/s10029-003-0194-1.CrossRefPubMed
4.
go back to reference Campanelli G, Pettinari D, Nicolosi FM, Cavalli M, Avesani EC: Inguinal hernia recurrence: classification and approach. Hernia. 2006, 10 (2): 159-161. 10.1007/s10029-005-0053-3.CrossRefPubMed Campanelli G, Pettinari D, Nicolosi FM, Cavalli M, Avesani EC: Inguinal hernia recurrence: classification and approach. Hernia. 2006, 10 (2): 159-161. 10.1007/s10029-005-0053-3.CrossRefPubMed
5.
go back to reference Memon MA, Feliu X, Sallent EF, Camps J, Fitzgibbons RJ: Laparoscopic repair of recurrent hernias. Surg Endosc. 1999, 13 (8): 807-810. 10.1007/s004649901105.CrossRefPubMed Memon MA, Feliu X, Sallent EF, Camps J, Fitzgibbons RJ: Laparoscopic repair of recurrent hernias. Surg Endosc. 1999, 13 (8): 807-810. 10.1007/s004649901105.CrossRefPubMed
6.
go back to reference Nyhus LM, Pollak R, Bombeck CT, Donahue PE: The preperitoneal approach and prosthetic buttress repair for recurrent hernia. The evolution of a technique. Ann Surg. 1988, 208 (6): 733-737. 10.1097/00000658-198812000-00010.CrossRefPubMedPubMedCentral Nyhus LM, Pollak R, Bombeck CT, Donahue PE: The preperitoneal approach and prosthetic buttress repair for recurrent hernia. The evolution of a technique. Ann Surg. 1988, 208 (6): 733-737. 10.1097/00000658-198812000-00010.CrossRefPubMedPubMedCentral
7.
go back to reference Aasvang E, Kehlet H: Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaes. 2005, 95 (1): 69-76. 10.1093/bja/aei019.CrossRef Aasvang E, Kehlet H: Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaes. 2005, 95 (1): 69-76. 10.1093/bja/aei019.CrossRef
8.
go back to reference Katri KM: Open preperitoneal mesh repair of recurrent inguinal hernia. Hernia. 2009, 13: 585-589. 10.1007/s10029-009-0520-3.CrossRefPubMed Katri KM: Open preperitoneal mesh repair of recurrent inguinal hernia. Hernia. 2009, 13: 585-589. 10.1007/s10029-009-0520-3.CrossRefPubMed
10.
go back to reference Saber A: Effect of Intergel versus Honey in Intraperitoneal Adhesion Prevention and Colonic Anastomotic Healing: A Comparative Experimental Study in Rats. Thesis (MD). 2005, Faculty of Medicine, Suez-Canal University Saber A: Effect of Intergel versus Honey in Intraperitoneal Adhesion Prevention and Colonic Anastomotic Healing: A Comparative Experimental Study in Rats. Thesis (MD). 2005, Faculty of Medicine, Suez-Canal University
11.
go back to reference Schwab R, Conze J, Willms A, Klinge U, Becker HP, Schumpelick V: Management of recurrent inguinal hernia after previous mesh repair: a challenge. Chirurg. 2006, 77 (6): 523-530. 10.1007/s00104-006-1158-7.CrossRefPubMed Schwab R, Conze J, Willms A, Klinge U, Becker HP, Schumpelick V: Management of recurrent inguinal hernia after previous mesh repair: a challenge. Chirurg. 2006, 77 (6): 523-530. 10.1007/s00104-006-1158-7.CrossRefPubMed
12.
go back to reference Kouhia ST, Huttunen R, Silvasti SO, Heiskanen JT, Ahtola H, Uotila-Nieminen M, Kiviniemi VV, Hakala T: Lichtenstein hernioplasty versus totally extraperitoneal laparoscopic hernioplasty in treatment of recurrent inguinalhernia- a prospective randomized trial. Ann Surg. 2009, 249 (3): 384-387. 10.1097/SLA.0b013e318196d0b0.CrossRefPubMed Kouhia ST, Huttunen R, Silvasti SO, Heiskanen JT, Ahtola H, Uotila-Nieminen M, Kiviniemi VV, Hakala T: Lichtenstein hernioplasty versus totally extraperitoneal laparoscopic hernioplasty in treatment of recurrent inguinalhernia- a prospective randomized trial. Ann Surg. 2009, 249 (3): 384-387. 10.1097/SLA.0b013e318196d0b0.CrossRefPubMed
13.
go back to reference Millat B: Fédération de Recherche EN CHirurgie (FRENCH). Inguinal hernia repair. A randomized multicentric study comparing laparoscopic and open surgical repair. J Chir (Paris). 2007, 144 (2): 119-124.CrossRef Millat B: Fédération de Recherche EN CHirurgie (FRENCH). Inguinal hernia repair. A randomized multicentric study comparing laparoscopic and open surgical repair. J Chir (Paris). 2007, 144 (2): 119-124.CrossRef
14.
go back to reference Farooq O, Batool Z, Din AU, Ullah AA, Butt Q, Kibryia RI: Anterior tension - free repair versus posterior preperitoneal repair for recurrent hernia. J Coll Physicians Surg Pak. 2007, 17 (8): 465-468.PubMed Farooq O, Batool Z, Din AU, Ullah AA, Butt Q, Kibryia RI: Anterior tension - free repair versus posterior preperitoneal repair for recurrent hernia. J Coll Physicians Surg Pak. 2007, 17 (8): 465-468.PubMed
15.
go back to reference Kurzer M, Belsham PA, Kark AE: Prospective study of open preperitoneal mesh repair for recurrent inguinal hernia. Br J Surg. 2002, 89 (1): 90-93. 10.1046/j.0007-1323.2001.01956.x.CrossRefPubMed Kurzer M, Belsham PA, Kark AE: Prospective study of open preperitoneal mesh repair for recurrent inguinal hernia. Br J Surg. 2002, 89 (1): 90-93. 10.1046/j.0007-1323.2001.01956.x.CrossRefPubMed
16.
go back to reference Nyhus LM: Iliopubic tract repair of inguinal and femoral hernia. The posterior (preperitoneal) approach. Surg Clin North Am. 1993, 73: 487-499.PubMed Nyhus LM: Iliopubic tract repair of inguinal and femoral hernia. The posterior (preperitoneal) approach. Surg Clin North Am. 1993, 73: 487-499.PubMed
17.
go back to reference Feliu X, Torres G, Viñas X, Martνnez-Ródenas F, Fernández-Sallent E, Pie J: Preperitoneal repair for recurrent inguinal hernia: laparoscopic and open approach. Hernia. 2004, 8: 113-116. 10.1007/s10029-003-0179-0.CrossRefPubMed Feliu X, Torres G, Viñas X, Martνnez-Ródenas F, Fernández-Sallent E, Pie J: Preperitoneal repair for recurrent inguinal hernia: laparoscopic and open approach. Hernia. 2004, 8: 113-116. 10.1007/s10029-003-0179-0.CrossRefPubMed
18.
go back to reference Günal O, Ozer S, Gürleyik E, Bahçebaşi T: Does the approach to the groin make a difference in hernia repair?. Hernia. 2007, 11 (5): 429-434. 10.1007/s10029-007-0252-1.CrossRefPubMed Günal O, Ozer S, Gürleyik E, Bahçebaşi T: Does the approach to the groin make a difference in hernia repair?. Hernia. 2007, 11 (5): 429-434. 10.1007/s10029-007-0252-1.CrossRefPubMed
19.
go back to reference Karatepe O, Acet E, Altiok M, Adas G, Cakır A, Karahan S: Preperitoneal repair (open posterior approach) for recurrent inguinal hernias previously treated with Lichtenstein tension-free hernioplasty. Hippokratia. 2010, 14 (2): 119-121.PubMedPubMedCentral Karatepe O, Acet E, Altiok M, Adas G, Cakır A, Karahan S: Preperitoneal repair (open posterior approach) for recurrent inguinal hernias previously treated with Lichtenstein tension-free hernioplasty. Hippokratia. 2010, 14 (2): 119-121.PubMedPubMedCentral
20.
go back to reference Johansson B, Hallerbäck B, Glise H, Anesten B, Smedberg S, Román J: Laparoscopic mesh versus open preperitoneal mesh versus conventional technique for inguinal hernia repair a randomized multicenter trial (SCUR Hernia Repair Study). Ann Surg. 1999, 230 (2): 225-10.1097/00000658-199908000-00013.CrossRefPubMedPubMedCentral Johansson B, Hallerbäck B, Glise H, Anesten B, Smedberg S, Román J: Laparoscopic mesh versus open preperitoneal mesh versus conventional technique for inguinal hernia repair a randomized multicenter trial (SCUR Hernia Repair Study). Ann Surg. 1999, 230 (2): 225-10.1097/00000658-199908000-00013.CrossRefPubMedPubMedCentral
21.
go back to reference Schrenk P, Woisetschlager R, Rieger R, Wayand W: Prospective randomized trial comparing postoperative pain and return to physical activity after transabdominal preperitoneal, total preperitoneal or Shouldice technique for inguinal hernia repair. Br J Surg. 1997, 83: 728-729. Schrenk P, Woisetschlager R, Rieger R, Wayand W: Prospective randomized trial comparing postoperative pain and return to physical activity after transabdominal preperitoneal, total preperitoneal or Shouldice technique for inguinal hernia repair. Br J Surg. 1997, 83: 728-729.
22.
go back to reference Courtney CA, Duffy K, Serpell MG: Outcome of patients with severe chronic pain following repair of groin hernia. Br J Surg. 2002, 89: 1310-1314. 10.1046/j.1365-2168.2002.02206.x.CrossRefPubMed Courtney CA, Duffy K, Serpell MG: Outcome of patients with severe chronic pain following repair of groin hernia. Br J Surg. 2002, 89: 1310-1314. 10.1046/j.1365-2168.2002.02206.x.CrossRefPubMed
23.
go back to reference Vrijland WW, van den Tol MP, Luijendijk RW: Randomized clinical trial of non-mesh versus mesh repair of primary inguinal hernia. Br J Surg. 2002, 89: 293-297. 10.1046/j.0007-1323.2001.02030.x.CrossRefPubMed Vrijland WW, van den Tol MP, Luijendijk RW: Randomized clinical trial of non-mesh versus mesh repair of primary inguinal hernia. Br J Surg. 2002, 89: 293-297. 10.1046/j.0007-1323.2001.02030.x.CrossRefPubMed
24.
go back to reference Aasvang EK, Gmaehle E, Hansen JB, Gmaehle B, Forman JL, Schwarz J, Bittner R, Kehlet H: Predictive risk factors for persistent postherniotomy pain. Anesthesiology. 2010, 112 (4): 957-969. 10.1097/ALN.0b013e3181d31ff8.CrossRefPubMed Aasvang EK, Gmaehle E, Hansen JB, Gmaehle B, Forman JL, Schwarz J, Bittner R, Kehlet H: Predictive risk factors for persistent postherniotomy pain. Anesthesiology. 2010, 112 (4): 957-969. 10.1097/ALN.0b013e3181d31ff8.CrossRefPubMed
25.
26.
go back to reference Erhan Y, Erhan E, Aydede H, Mercan M, Tok D: Chronic pain after Lichtenstein and preperitoneal (posterior) hernia repair. Can J Surg. 2008, 51 (5): 383-387.PubMedPubMedCentral Erhan Y, Erhan E, Aydede H, Mercan M, Tok D: Chronic pain after Lichtenstein and preperitoneal (posterior) hernia repair. Can J Surg. 2008, 51 (5): 383-387.PubMedPubMedCentral
27.
go back to reference Poobalan AS, Bruce J, King PM: Chronic pain and quality of life following open inguinal hernia repair. Br J Surg. 2001, 88: 1122-1126. 10.1046/j.0007-1323.2001.01828.x.CrossRefPubMed Poobalan AS, Bruce J, King PM: Chronic pain and quality of life following open inguinal hernia repair. Br J Surg. 2001, 88: 1122-1126. 10.1046/j.0007-1323.2001.01828.x.CrossRefPubMed
28.
go back to reference Wright D, Paterson C, Scott N: Five-year follow-up of patients undergoing laparoscopic or open groin hernia repair: a randomized controlled trial. Ann Surg. 2002, 235: 333-337. 10.1097/00000658-200203000-00004.CrossRefPubMedPubMedCentral Wright D, Paterson C, Scott N: Five-year follow-up of patients undergoing laparoscopic or open groin hernia repair: a randomized controlled trial. Ann Surg. 2002, 235: 333-337. 10.1097/00000658-200203000-00004.CrossRefPubMedPubMedCentral
29.
go back to reference Staal E, Nienhuijs SW, Keemers-Gels ME, Rosman C, Strobbe LJ: The impact of pain on daily activities following open mesh inguinal hernia repair. Hernia. 2008, 12 (2): 153-157. 10.1007/s10029-007-0297-1.CrossRefPubMed Staal E, Nienhuijs SW, Keemers-Gels ME, Rosman C, Strobbe LJ: The impact of pain on daily activities following open mesh inguinal hernia repair. Hernia. 2008, 12 (2): 153-157. 10.1007/s10029-007-0297-1.CrossRefPubMed
30.
go back to reference Nienhuijs S, Staal E, Strobbe L, Rosman C, Groenewoud H, Bleichrodt R: Chronic pain after mesh repair of inguinal hernia: a systematic review. Am J Surg. 2007, 194 (3): 394-400. 10.1016/j.amjsurg.2007.02.012. ReviewCrossRefPubMed Nienhuijs S, Staal E, Strobbe L, Rosman C, Groenewoud H, Bleichrodt R: Chronic pain after mesh repair of inguinal hernia: a systematic review. Am J Surg. 2007, 194 (3): 394-400. 10.1016/j.amjsurg.2007.02.012. ReviewCrossRefPubMed
31.
go back to reference Nienhuijs SW, Van Oort I, Keemers-Gels ME, Strobbe LJ, Rosman C: Randomized trial comparing the Prolene Hernia System, mesh plug repair and Lichtenstein method for open inguinal hernia repair. Br J Surg. 2005, 92 (1): 33-38. 10.1002/bjs.4702.CrossRefPubMed Nienhuijs SW, Van Oort I, Keemers-Gels ME, Strobbe LJ, Rosman C: Randomized trial comparing the Prolene Hernia System, mesh plug repair and Lichtenstein method for open inguinal hernia repair. Br J Surg. 2005, 92 (1): 33-38. 10.1002/bjs.4702.CrossRefPubMed
32.
go back to reference Farooq O: Bashir-ur-Rehman. Recurrent inguinal hernia repair by open preperitoneal approach. J Coll Physicians Surg Pak. 2005, 15 (5): 261-265.PubMed Farooq O: Bashir-ur-Rehman. Recurrent inguinal hernia repair by open preperitoneal approach. J Coll Physicians Surg Pak. 2005, 15 (5): 261-265.PubMed
33.
go back to reference Beg MA, Mehdi SH, Siddiqui SS: Early complications of inguinal hernia repair. Professional Med J. 2007, 14 (1): 119-122. Beg MA, Mehdi SH, Siddiqui SS: Early complications of inguinal hernia repair. Professional Med J. 2007, 14 (1): 119-122.
34.
go back to reference Bax T, Sheppard BC, Crass RA: Surgical options in the management of groin hernias. Am Fam Physician. 1999, 59 (4): 893-906. ReviewPubMed Bax T, Sheppard BC, Crass RA: Surgical options in the management of groin hernias. Am Fam Physician. 1999, 59 (4): 893-906. ReviewPubMed
35.
go back to reference Liem MSL, van Duyn EB, van der Graaf Y, Theo JMV, van Vroonhoven TJMV, on behalf of the Coala Trial Group: Recurrences after conventional anterior and laparoscopic inguinal hernia repair a randomized comparison. Ann Surg. 2003, 237 (1): 136-141. 10.1097/00000658-200301000-00019.CrossRefPubMedPubMedCentral Liem MSL, van Duyn EB, van der Graaf Y, Theo JMV, van Vroonhoven TJMV, on behalf of the Coala Trial Group: Recurrences after conventional anterior and laparoscopic inguinal hernia repair a randomized comparison. Ann Surg. 2003, 237 (1): 136-141. 10.1097/00000658-200301000-00019.CrossRefPubMedPubMedCentral
36.
go back to reference Moore JB, Hasenboehler EA: Orchiectomy as a result of ischemic orchitis after laparoscopic inguinal hernia repair: case report of a rare complication. Patient Saf Surg. 2007, 7 (1): 1-3. Moore JB, Hasenboehler EA: Orchiectomy as a result of ischemic orchitis after laparoscopic inguinal hernia repair: case report of a rare complication. Patient Saf Surg. 2007, 7 (1): 1-3.
37.
go back to reference Chu L, Averch TD, Jackman SV: Testicular infarction as a sequela of inguinal hernia repair. Can J Urol. 2009, 16 (6): 4953-4954.PubMed Chu L, Averch TD, Jackman SV: Testicular infarction as a sequela of inguinal hernia repair. Can J Urol. 2009, 16 (6): 4953-4954.PubMed
Metadata
Title
Open preperitoneal versus anterior approach for recurrent inguinal hernia: a randomized study
Authors
Aly Saber
Goda M Ellabban
Mohammad A Gad
Karam Elsayem
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Surgery / Issue 1/2012
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/1471-2482-12-22

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