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Effect of Previous Lower Abdominal Surgery on Outcomes Following Totally Extraperitoneal (TEP) Inguinal Hernia Repair

Prassas, Dimitrios MD*,†; Ntolia, Argyro MD*; Brosa, Julia MD*; Kounnamas, Aristodemos MD; Rolfs, Thomas-Marten MD*; Schumacher, Franz-Josef MD*; Krieg, Andreas MD

Surgical Laparoscopy Endoscopy & Percutaneous Techniques: August 2019 - Volume 29 - Issue 4 - p 267–270
doi: 10.1097/SLE.0000000000000633
Original Articles

Background: Previous lower abdominal surgery is generally considered as a relative contraindication for laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. Our objective was to investigate the feasibility and safety of TEP repair in patients with a history of lower abdominal surgery.

Materials and Methods: A retrospective analysis of 301 patients with inguinal hernia who underwent elective laparoscopic TEP repair between August 2010 and August 2014 was conducted. One-hundred five patients (34.9%) had previously undergone lower abdominal surgery. The main outcome measures included intraoperative and postoperative morbidity and mortality. Secondary outcomes were immediate postoperative pain, presence of chronic pain at follow-up, and hernia recurrence.

Results: Patient demographics and clinical variables were balanced between the 2 groups, with the exception of age. Intraoperative morbidity was similar between cases without previous lower abdominal surgery (nPS) and cases with history of lower abdominal surgery (PS) [nPS vs. PS: 0.5% (n=1) vs. 2.8% (n=3), P=0.09]. Overall 30-day morbidity was found to be significantly higher in the PS patient group [nPS vs. PS: 1.5% (n=3) vs. 6.6% (n=7), P=0.018]. Mortality was nil. There were no differences noted between the 2 groups with respect to early postoperative pain and chronic inguinal pain. Complete follow-up information was available for 149 of 301 patients (follow-up rate of 49.5%, range: 3 to 48 mo) with a mean follow-up time of 20.38 months (SD=7.7). There was no statistically significant difference noted in the recurrence rate between the 2 patient groups at follow-up [nPS vs. PS: 3.2% (n=3) vs. 1.8% (n=1), P=0.6].

Conclusions: The present work demonstrates higher incidence of postoperative scrotal hematoma after TEP repair in patients with history of previous lower abdominal surgery. All remaining outcomes of interest were found to be similar between the 2 patient groups. Further trials will be needed to verify our findings.

*Department of Surgery, Katholisches Klinikum Oberhausen, Teaching Hospital of the University of Duisburg-Essen, Oberhausen

Department of Surgery (A), Heinrich Heine University Duesseldorf, Duesseldorf

Department of Surgery, Alexianer Hospital Krefeld, Krefeld, Germany

All procedures performed in this study involving human participants were in accordance with the ethical standards of the Institutional and/or National Research Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the ethics committee of our institution. Informed consent was obtained from all individual participants included in the study.

The study was privately funded. The authors declare no conflicts of interest.

Reprints: Dimitrios Prassas, MD, Moorenstrasse 5, 46225 Düsseldorf, Germany (e-mail:

Received September 22, 2018

Accepted December 18, 2018

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