Aim:
The incidence of recurrent hernia after primary repair of the inguinal hernia ranges from 1% to 20%. There is still controversy over the selection and use of anterior versus posterior approach in the repair of recurrent inguinal hernias. The present study evaluated the outcomes achieved in patients who were operated on using the two methods.
Methods:
This retrospective study included a total of 109 patients, who underwent an operation due to recurrent inguinal hernia in a period of 15 years. Posterior preperitoneal mesh repair was performed in 60 patients and anterior approach using Lichtenstein technique was used in the remaining 49 patients. Polypropylene mesh graft was used in the repair and the patients were compared after control visits at one week, one month, six moths and one year. The chi-square test and Student’s t-test were used in the statistical analysis.
Results:
The mean length of hospital stay was 1.9 days in the posterior approach group and 1 day in the anterior approach group. Of the patients who underwent repair using posterior approach, 57 were male and three were female with a mean age of 55.2 (range 25-80) years. Of the patients who underwent repair using anterior approach, 46 were male and three were female with a mean age of 56.6 (18-82) years. The rate of postoperative complications was 8.3% in the posterior approach group and 6% in the anterior approach group.
Conclusion:
Surgical procedures involving anterior approach are commonly preferred in the repair of inguinal hernias due to short procedure time, favorable safety profile and lower morbidity rates, however, these procedures pose the disadvantages of difficulty of accessing the recurrent hernia area and being time consuming surgery due to inflammation secondary to previous surgery as well as the risk of injury to the cord elements. Anterior approach can be used despite all these risk factors, but placement of mesh into the intact preperitoneal area can also be used as a safe procedure.
Keywords: Recurrent inguinal hernia, anterior herniorraphy, posterior herniorraphy