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Recurrent inguinal hernia repair by open preperitoneal approach.

OBJECTIVE
To evaluate the open preperitoneal hernia repair for safety, testicular complications and recurrence rate.


DESIGN
Prospective cohort study.


PLACE AND DURATION OF STUDY
Combined Military Hospital, Muzaffarabad AJ and K from March 1997 to April 2001.


SUBJECTS AND METHODS
Sixty-five consecutive male patients above the age of 25 years, with unilateral recurrent inguinal hernia underwent open preperitoneal hernia repair using polypropylene mesh. Scrotal or irreducible/obstructed hernias were also included in the study. Patients with primary inguinal hernia were excluded from the study. Patients with class 11/111 obesity (BMI > 35) and patients with ASA grade 3 and beyond were also excluded. Preperitoneal space was entered through a transverse lower abdominal incision placed 3 cm above the inguinal ligament. Mesh was anchored using 2/0 polypropylene interrupted sutures. Forty-two patients were operated under spinal while 23 patients had general anaesthesia. Patients were examined on 7th and 12th postoperative day for early complications. Subsequently they were examined at third month, six-month and then yearly for three years. Main outcome measures considered were intra-operative complications, postoperative testicular complications and re-recurrence.


RESULTS
Mean age in our study was 51 years. Fifty-one (78.4%) patients had direct while fourteen (21.6%) patients had indirect recurrence. There were two (3%) wound infections. One (1.5%) patient had hematoma formation. Three (4.6%) patients went into urinary retention postoperatively. There was no seroma formation, no case of bladder or intestinal injury. None of the patients developed any testicular complication or chronic residual neuralgia. There was only one (1.5%) case of re-recurrence during second year of repair.


CONCLUSION
Open preperitoneal repair for recurrent inguinal hernia is safe procedure. It effectively eliminates testicular complications and has a very low recurrence rate.