Re-recurrence After Operation for Recurrent Inguinal Hernia. A Nationwide 8-Year Follow-up Study on the Role of Type of Repair

In Brief Objectives: We analyze, on a nationwide basis, the risk of re-reoperation with reference to previous inguinal hernia repair technique. Summary Background Data: Operation for a recurrent inguinal hernia is common and the risk of re-recurrence is high. There are no large-scale data evaluating the surgical strategy and results after recurrent inguinal hernia repairs. Methods: Prospective recording of all primary and subsequent recurrent inguinal hernia repairs from January 1, 1998 to December 31, 2005, in the national Danish Hernia Database, using the reoperation rate as a proxy for recurrence. The re-reoperation rate was analyzed with reference to the technique of primary and recurrent inguinal hernia repair. Results: After 67,306 primary hernia repairs there were 2117 reoperations (3.1%) and 187 re-reoperations (8.8%). The cumulated re-reoperation rate after primary Lichtenstein repair (n = 1124) was significantly reduced after laparoscopic operation for recurrence (1.3% (95% CI: 0.4–3.0)) compared with open repairs for recurrence (Lichtenstein 11.3% (8.2–15.2), nonmesh 19.2% (14.0–25.4), mesh (non-Lichtenstein) 7.2% (4.0 – 11.8)). After primary nonmesh (n = 616), non-Lichtenstein mesh (n = 277), and laparoscopic repair (n = 100) there was no significant difference in re-reoperation rates between a laparoscopic repair and all open techniques of repair for recurrence. Conclusion: Laparoscopic repair is recommended for reoperation of a recurrence after primary open Lichtenstein repair. This nationwide prospective study based on 67,306 primary hernias provides firm evidence for laparoscopic repair of a recurrence after a primary Lichtenstein mesh repair to reduce the risk of re-reoperation.