부산대학교 도서관

Aims: There is little good evidence available on the management of recurrent inguinal hernias; despite this, the National Institute of Clinical Excellence recently suggested that laparoscopic repair is superior. This study was a review of recurrent hernia repairs performed in a district general hospital by six consultant surgeons. Methods: A case note review was performed of all inguinal hernia recurrences from 1991 to 2001 inclusive. Some 171 cases were examined, 92 per cent of those identified on database. The average age at recurrence was 64 years and 4 per cent were women. Some 49 per cent of the original operations had been performed locally and primary operation notes were available. In these, the original repair type was open nylon repair in 54 per cent, open mesh repair in 18 per cent and laparoscopic repair in 8 per cent. Results: Recurrence was seen more frequently on the right (61 per cent) than the left (39 per cent). Hernia recurrence was managed by open mesh technique in 63 per cent and laparoscopically in 22 per cent of patients. Complication rates were highest after emergency repair – all of these hernias were repaired by open methods with a complication rate of 50 per cent and one death. In elective repair, complication rates were similar after mesh repair (15 per cent) and laparoscopic repair (11 per cent). The length of stay in the two groups was comparable at 1.2 and 1.3 days, respectively. A single recurrence was seen in each group. Conclusions: This 10-year experience demonstrates equivalent results for laparoscopic or open repair of recurrent hernias refuting current N.I.C.E. guidelines. A large randomized controlled trial is necessary to compare methods of repair of recurrent inguinal hernia. [ABSTRACT FROM AUTHOR]