Laparoscopic and endoscopic procedures generally are accepted for repair of primary and recurrent
hernias that follow conventional (anterior) repair. This report discusses transabdominal preperitoneal (
TAPP) for incarcerated
hernias, scrotal
hernias, and
hernias after radical
prostatectomy, as well as
hernia recurrences after
TAPP and totally extraperitoneal (
TEP) procedures (complex
hernias). Studies with long-term results of
hernia recurrences are missing. This study aimed to determine
hernia recurrence rates for adults after a modified
TAPP procedure. The records of patients who had
hernia repair surgery at a general hospital 2, 7, 12, and 17 years earlier were analyzed. Living patients were requested to complete a questionnaire to
complement information from their hospital records.
METHODS: A retrospective analysis was undertaken that included 5,764 patients who had undergone
hernia repair surgery 2-17 years earlier at a single large center. Between 1993 and 2009, a modified
TAPP procedure was performed for 5,764 patients (median age, 59.1 years) to repair 6,776
hernias (93.9% of all
hernia repairs), including 6,126 primary
hernias (87.4%) and 884 recurrent
hernias (12.6%). These included 994 complicated
hernias (14.2%) closed by a modified
TAPP (89.3% of all
femoral hernias, 85.9% of scrotal
hernias, 79.1% of incarcerated
hernias, and 92.7% of
hernias after radical
prostatectomy). Limited financial and staff resources did not permit a quantitative follow-up study within a reasonable time of all 5,764 patients who had
hernia surgery 2-18 years earlier. To obtain quantitative results of
hernia recurrences after a modified
TAPP, the patients were divided into four subgroups and requested to complete a questionnaire. These four patient subgroups whose surgeries had been performed 2 years earlier (241 patients with 277
hernias), 7 years earlier (285 patients with 376
hernias), 12 years earlier (401 patients with 544
hernias), and 17 years earlier (181 patients with 222
hernias) represented the complete group of
hernia sufferers. Patients with symptoms after
hernia surgery (n = 5) were invited for a medical checkup by a specialist in
hernia surgery at our outpatient unit.
RESULTS: The sex, age, and the number of complex
hernias of the patients did not differ significantly among the four patient subgroups or in comparison with the entire group. The patients who had received surgery in 1994, 1999, 2004, and 2009 were quizzed by a questionnaire and represented all patients who had
hernia surgery from 1993 to 2009. The follow-up response of the living patients in each of the subgroups ranged from 89.5% of those who had
hernia surgery 17 years earlier to 95.9% of those who had surgery 2 years earlier. The primary end point of the study was the
hernia recurrence rate after a modified
TAPP for primary, recurrent, and complex
hernias performed 2, 7, 12, and 17 years earlier. The secondary end points of the study focused on the following questions: Is a modified
TAPP practicable with acceptable recurrence rates for complex
hernias? Do relapse rates show individual surgeon-dependent differences in relation to the learning curve? How many years of postoperative follow-up evaluation are required to determine quantitative recurrence rates (>90% recurrence)? All inguinal and
femoral hernias were repaired with a modified
TAPP procedure.
Hernia defects larger than 1 × 1 cm were closed with nonabsorbable
sutures before the mesh was implanted. Within 17 years after surgery, 4 (4.3%) of the 94 study participants treated with a modified
TAPP procedure for primary or recurrent inguinal and
femoral hernias experienced recurrent
hernias (4 recurrences after 117
hernioplasties, 3.4%). Within 12 years after surgery, 4 (1 %) of 302 patients experienced recurrent
hernias (4 recurrences after 398 modified
TAPP procedures, 1%). Within 7 years after surgery for inguinal or
femoral hernias, 8 (3.2%) of 251 patients had relapsed (8 recurrences after 337 modified
TAPP procedures, 2.4%). Within 2 years after a modified
TAPP, only 1 of 230 patients (0.4%) experienced a recurrent
hernia (1 relapse after 265
hernioplasties, 0.4%). After the modified
TAPP procedure, 52.9% (n = 9) of the patients with a recurrent
hernia had a second repair at our hospital, and 35.3% (n = 6) had the second repair at other hospitals, whereas 2 patients (11.8 %) renounced a repeat surgical intervention. The recurrence rate after a modified
TAPP procedure for all the patients (n = 896) was 1.8%. The study participants with primary
hernias (n = 765) had a 1.7% recurrence rate, whereas the rate for recurrent
hernias after anterior repair (n = 131) was 2.3 %. Incarcerated
hernias (n = 47) and
hernias after radical
prostatectomy (n = 22) that were closed by the modified
TAPP procedure resulted in no
hernia recurrences. Only 1 of 47 patients with scrotal
hernias had a
hernia relapse. Of all the
hernia recurrences between 1993 and 2009 (n = 76), 60.5% (n = 46) developed within 2 years after surgery, whereas 15.8% (n = 12) occurred after more than 5 years, and 4% (n = 3) occurred after more than 10 years. The recurrence rates also were higher for surgeons in the early period after completion of their personal learning curves (<50 modified
TAPP procedures performed on their own responsibility).
CONCLUSIONS: In a retrospective long-term study (2-17 years) from a single center with 1,108 patients and 1,123 modified
TAPP procedures (93.9% of all
hernia repairs), the
hernia recurrence rate was 1.7% for adults with primary
hernias (n = 765 patients) and 2.3% for adults with recurrent
hernias after anterior repair (n = 131 patients). A modified
TAPP procedure with suturing of
hernia defects larger than 1 × 1 cm can be used as the standard procedure without recurrences for
femoral hernias, incarcerated
hernias, and
hernias after radical
prostatectomy, with low recurrence rates for scrotal
hernias (2%). To collect quantitative data on
hernia recurrence rates, postoperative follow-up studies longer than 10 years are needed (4% of recurrences developed later than 10 years after surgery).