Laparoscopic hernia repair has the short term advantage of less post-op pain and shorter sick leave.
Bokeler 2008 Anterior (not sp.) TAPP 0.60% NA
n = 1,689 patients
n = 1,755 recurrent hernias
Laparoscopic hernia repair should be the “Gold standard” in the treatment of recurrent hernias after anterior repair, but it is essential to gain experience by using the laparoscopic technique for primary hernias.
Recurrence after TAPP for Prior Hernia Repair Recurrence
Review of prospective Lichtenstein (n = 344) 11.3%
Danish hernia registry Nonmesh (n = 198) 19.2%
n = patient total not provided Mesh (non-Lichtenstein) (n = 194) 7.2%
n = 1,124 recurrent hernias
Laparoscopic repair is recommended for reoperation of recurrence after primary open Lichtenstein repair. Trend favors laparoscopic repair of recurrence after non-mesh and non-Lichtenstein mesh primary repair. Laparoscopic repair of recurrence after laparoscopic primary repair shows no advantage in terms of re-recurrence.
Study Primary Repair Recur. Repair Techn. Re-recurrence Follow up
Knook 1999 Various Laparoscopic TAPP 0.0% 35 months
Review (n = 34)
n = 34 patients
n = 34 recurrent hernias
TAPP is a reliable technique for repair of recurrent hernia prior endoscopic repair.
Liebl 2000 TAPP (n =44) TAPP 0.0% 26 months
Review of TEP (n = 2)
Single institution series
n = 44 patients
n = 46 recurrent hernias
Laparoscopic repair of recurrent inguinal hernia after TAPP can only be done by the transperitoneal approach. It is effective with low complication rates. It requires large mesh. For reoperation, it should be reserved for the experienced endoscopic surgeon.
Laparoscopic repair is recommended for reoperation of a recurrence after primary Lichtenstein repair. Trend favors laparoscopic repair of recurrence after non-mesh and non-Lichtenstein mesh primary repair. Laparoscopic repair of recurrence after laparoscopic primary repair shows no advantage in terms of re-recurrence.
TAPP after Recurrence of TAPP Hernia Repair
TAPP after präperit.mesh-rep. n = 135* op-time [median,min.] 75 morbidity 8,1 % reop.-rate 2,2 % rec.-rate 0,74 % return to work [med,d] 17 age [median] 59 [29-90] BMI [median] 25 Marienhospital Stuttgart IV / 93 – XII / 05 results Laparoscopic Hernia Repair (TAPP) *own recurrences n=73 from outside n=62
But Dr. TAPP, what about complications? … unless you “goldplate” your patient, there are going to be complications.
Laparoscopic posterior repair after posterior repair does not have the benefit of operating in virgin territory and may be best left to those surgeons with extensive laparoscopic experience.
Should the prior mesh be removed or left in place?
Sometimes the old mesh is difficult to remove and bowel and bladder injuries could occur (or the old plug just can’t be cut with scissors). “We left the prior mesh in situ. The dissection starts from the upper edge down behind the mesh, so the mesh remains at the peritoneum. It prevents damage to the peritoneum. Depending on the intra-operative situation we use a second mesh with or without a slit in a double-buttress technique”
Jochen Schwarz, personal correspondence
Dr. TAPP– are there anymore pitfalls of TAPP for repair of recurrent hernia?
Well Moneypenny, I guess that wraps things up here. Yes James… use of TAPP for recurrent inguinal hernias is mere child’s play compared with what’s ahead… “Q” will be in touch.
What’s this – Bill Fritz, a doctor, advertising for Coke… I thought he was taking care of my malpractice insurance! Back on the Turnpike…
Well, it looks like Dr. TAPP’s claims might be OK… if an expert beyond the learning curve is operating. Think I’ll just catch the new James Bond movie “Quantum of Solace”. November 2008