Repeat laparoscopic totally extraperitoneal hernia repair after primary laparoscopic totally extraperitoneal hernia repair for inguinal hernia

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.