Journal List > J Korean Surg Soc > v.77(3) > 1011004

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Kim, Choi, Sun, Ryu, Jang, Choi, and Park: Patterns of Recurrent Hernias according to the Types of Previous Hernioplasties
Original Article
Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2009; 77(3): 184-188.

Published online: 4 September 2009

DOI: https://doi.org/10.4174/jkss.2009.77.3.184

Patterns of Recurrent Hernias according to the Types of Previous Hernioplasties

Dong-Ju Kim, M.D., Han-Lim Choi, M.D., Woo-Young Sun, M.D., Dong-Hee Ryu, M.D., Lee-Chan Jang, M.D., Jae-Woon Choi, M.D., Jin-Woo Park, M.D.

Department of Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea.

Corresponding author (webjwpark@chungbuk.ac.kr)

Received 12 May 2009       Accepted 9 July 2009

Copyright © 2009 The Korean Surgical Society

Abstract

Purpose

Recently, conventional tissue repairs are gradually being replaced by tension-free hernioplasties using meshes (mesh repairs) in hernia surgery. The aim of the present study was to evaluate patterns of recurrent hernias according to the types of previous hernioplasties.

Methods

From August 2005 to July 2008, 18 hernioplasties were performed in recurrent cases at Chungbuk National University Hospital. All previous hernioplasties were performed at local hospitals except one case of ventral hernia. We reviewed the medical records and compared clinical features according to the types of previous hernioplasties.

Results

Among the 18 recurrent hernias, there were 15 inguinal including 2 pediatric cases, an umbilical, and 2 incisional hernias. Among 13 adult inguinal recurrent cases, 5 occurred after tissue repair (3 indirect, 1 direct, and 1 pantaloon type) and 8 after mesh repairs (direct type in all). Recurrence developed earlier after mesh repairs than tissue repairs (median [min~max]; 24 [0.1~164] vs. 243 [60~360] months, P=0.005). Other types of recurrence developed between 6 to 48 months after previous operations. Recurrent hernias after mesh repairs occurred preferentially along the margin of previous meshes. All cases were treated by mesh repairs except in pediatric cases. Median operation time and hospital stay for recurrent inguinal hernias were not different significantly by previous operations. Postoperative complications were minimal without recurrence during a median 5.5-(1.5~25.5)-month follow-up.

Conclusion

Recurrent hernias develop both after tissue repairs and mesh repairs. After mesh repairs, recurrences develop earlier and are more often associated with technical failure compared to tissue repairs.

Keywords: Recurrent hernia, Tissue repair, Tension-free hernioplasty, Mesh, Mesh shrinkage

Figures and Tables

Fig. 1
Plug and patch repair for a recurrent inguinal hernia after a Lichtenstein hernioplasty. Recurrence after a Lichtenstein hernioplasty preferentially occurs at around inferior medial side of patch just above pubic tubercle. Hernia sac is dissected and invaginated using mesh plug by Milikan technique.
jkss-77-184-g001
Table 1
Clinical characteristics of recurrent inguinal hernias
jkss-77-184-i001

*Latency of hernia recurrence = time interval between previous hernioplasty and recurrence; †Duration of symptom = time interval between recurrence and re-operation.

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