gms | German Medical Science

Background: Total extraperitoneal patch plastic (TEP) is one of the most commonly used minimal invasive techniques for inguinal hernia treatment. The recurrent rate is 1-5%. In recurrent cases after TEP, Lichtenstein procedure is the preferable operation. As a new and innovative alternative we present the Simplified Essen Method (SEM) for recurrent surgery after TEP.

Materials and methods: From January 2005 to September 2015 1895 patients were operated on for primary inguinal hernia with TEP. Fifty-four of these patients (52 male, age 65 ±13.3 years) developed a recurrent inguinal hernia and were operated on by Lichtenstein procedure (Group A , n=19) or SEM (Group B, n=35). The Lichtenstein procedure was performed in standard technique. In SEM the dislocated mesh was re-fixed to the inguinal ligament with non-resorbable sutures by an anterior approach. Retrospectively collected data included: gender, age, period between primary and recurrent operation, operating time, complications, duration of hospital stay, and re-recurrence.

Results: In Group A the period between the primary and recurrent operation was 55±47 month, in group B 48±54 month. Operating time was significantly shorter in Group B (48±25 minutes vs. 74.2±35 minutes, p<0.035). All complications were minor (hematoma, postoperative bleeding) with a similar complication rate in both groups (10.2% [Group A] vs. 5.7% [Group B] (n.s.). Hospital stay was 4.26±1.8 days (Group A) vs. 3.34±0.7 days (Group B) (p<0.017). After a mean follow-up of 54 ± 36.3 months in each group one re-recurrence was observed (n.s.).

Conclusion: The Simplified Essen Method (SEM) for recurrent inguinal hernias after TEP is as safe as the Lichtenstein procedure but avoids additional foreign body implantation and offers faster surgery. Therefore, SEM is our method of choice.