PURPOSE: Recently, conventional tissue repairs are gradually being replaced by tension-free hernioplasties using meshes (mesh repairs) in hernia surgery. The aim of the present study was to evaluate patterns of recurrent hernias according to the types of previous hernioplasties. METHODS: From August 2005 to July 2008, 18 hernioplasties were performed in recurrent cases at Chungbuk National University Hospital. All previous hernioplasties were performed at local hospitals except one case of ventral hernia. We reviewed the medical records and compared clinical features according to the types of previous hernioplasties. RESULTS: Among the 18 recurrent hernias, there were 15 inguinal including 2 pediatric cases, an umbilical, and 2 incisional hernias. Among 13 adult inguinal recurrent cases, 5 occurred after tissue repair (3 indirect, 1 direct, and 1 pantaloon type) and 8 after mesh repairs (direct type in all). Recurrence developed earlier after mesh repairs than tissue repairs (median [min~max]; 24 [0.1~164] vs. 243 [60~360] months, P=0.005). Other types of recurrence developed between 6 to 48 months after previous operations. Recurrent hernias after mesh repairs occurred preferentially along the margin of previous meshes. All cases were treated by mesh repairs except in pediatric cases. Median operation time and hospital stay for recurrent inguinal hernias were not different significantly by previous operations. Postoperative complications were minimal without recurrence during a median 5.5-(1.5~25.5)-month follow-up. CONCLUSION: Recurrent hernias develop both after tissue repairs and mesh repairs. After mesh repairs, recurrences develop earlier and are more often associated with technical failure compared to tissue repairs.
Adult ; Follow-Up Studies ; Hernia ; Hernia, Inguinal ; Hernia, Ventral ; Herniorrhaphy ; Humans ; Length of Stay ; Medical Records ; Postoperative Complications ; Recurrence

PURPOSE: Laparoscopic totally extraperitoneal (TEP) herniorrhaphy is an effective surgical technique for recurrent inguinal hernia. The recent introduction of various types of prosthetic mesh and the technical improvements in laparoscopic herniorrhaphy have allowed this modality to be used for various types of recurrent inguinal hernias, although careful selection of surgical techniques is required according to the patient's condition and the type of previous surgery. METHODS: One thousand and thirty cases were scheduled to undergo laparoscopic TEP herniorrhaphies from December of 2000 to August of 2008. We retrospectively collected and analyzed the data on the patient characteristics, the types of hernia, the number of previous recurrences, the operating technique, the operating time, the postoperative hospital stay and the postoperative complications. RESULTS: A total of 86 herniorrhaphies were performed in 83 patients with recurrent inguinal hernias. The mean patient age was 50.4 years. The total number of recurrences among the 83 patients was 118 cases and the number of recurrences was as follows: 1st in 65 patients, 2nd in 12 patients, 3rd in 7 patients and 4th in 2 patients. Eighty one laparoscopic TEP herniorrhaphies were performed, and 5 cases were performed by laparoscopic transabdominal preperitoneal repair or laparoscopic intraperitoneal onlay mesh repair. The mean operative time was 29.9 minutes, and there was no statistical correlation between the type of prior herniorrhaphy and the operative time. The mean postoperative hospital stay was 0.9 days and no major complications occurred. CONCLUSION: Selecting the type of surgery to perform for treating recurrent inguinal hernia has become complicated due to many recent diversified techniques of herniorrhaphy. Although laparoscopic TEP herniorhaphy is effective for treating recurrent inguinal hernia, a meticulous approach and various surgical techniques are required when prosthetic mesh has been previously placed on the preperitoneal space.
Hernia ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Inlays ; Length of Stay ; Operative Time ; Postoperative Complications ; Pyrazines ; Recurrence ; Retrospective Studies

PURPOSE: The mesh technique of inguinal hernia repair has revealed encouraging results in groin hernia repair. However, there are few reports in Korea analyzing the clinical results of the mesh technique compared with the non-mesh method of inguinal hernia repair. METHODS: Information was assimilated from randomized trials comparing the mesh and non-mesh methods in order to assess both benefits and safety. The clinical results of the mesh technique (n=38) and the non-mesh method (n=33) were compared. The clinical features analyzed were age, sex, location, type of hernia, surgical time, use of postoperative analgesics, length of hospital stay, complication and recurrence. RESULTS: There was no significant difference between the mesh technique and the non-mesh method on sex, age, location, type of hernia. The average operation time was significantly longer in the mesh group than the non-mesh group (P<0.01, 60.9 min vs 46.8 min). The average number of analgesics used was significantly smaller in the mesh group than the non-mesh group (P<0.01, 4.6 vs 8.2). The average duration of hospital stay was statistically shorter in the mesh group than the non-mesh group (P<0.01, 4.5 days vs 6.3 days). Postoperative complications were observed in only one case (hematoma) in the non-mesh group. Recurrence rate in the non-mesh group was 9% (3 cases), although there was no recurrence in a mesh group. CONCLUSION: The mesh technique of inguinal hernia repairis a useful technique because it is less painful and causes a shorter hospital stay than the non-mesh method. In this study, we observed not a shortened surgical time and lower recurrence rate in the mesh group than in non-mesh.
Analgesics ; Groin ; Hernia ; Hernia, Inguinal* ; Herniorrhaphy ; Korea ; Length of Stay ; Operative Time ; Postoperative Complications ; Recurrence

Prophylactic contralateral exploration in unilateral inguinal hernia repair is still controversial. The purpose of this study is to analyze the contralateral incidence of hernia and to verify the necessity of the simultaneous contralateral exploration. Infants and children operated on for inguinal hernia or hydrocele at the Department of Pediatric Surgery of Asan Medical Center from January 1996 to December 2005 were analyzed retrospectively. A total of 383 patients (9.8 %) out of 3,925 patients underwent a simultaneous bilateral operation. A total of 222 patients (6.2 %) out of 3,542 patients underwent a secondary metachronous contralateral operation after primary unilateral inguinal hernia or hydrocele repair. Because simultaneous bilateral operation cases included true bilateral inguinal hernia or hydrocele, and unilateral hernia and simultaneous contralateral exploration, bilateral incidence of inguinal hernia and hydrocele could be maximally considered as 15.4% (605 patients). Therefore, the prophylactic contralateral exploration in unilateral inguinal hernia or hydrocele should be determined carefully in considering history and physical examination of the patients, and postoperative complications.
Child ; Hernia ; Hernia, Inguinal ; Humans ; Incidence ; Infant ; Physical Examination ; Postoperative Complications ; Retrospective Studies

PURPOSE: A balloon dissector is widely used to achieve the preperitoneal space in totally extraperitoneal (TEP) inguinal hernia repair. The aim of this study was to compare the operative results of TEP cases performed with (the balloon dissection group) or without (the plain dissection group) a balloon dissector. METHODS: A retrospective analysis was conducted with a consecutive series of inguinal hernia repairs performed by a single surgeon in OOO Hospital between April 2008 and April 2012. All 128 patients with full-length video recordings were included. The distribution of the operation method was altered during the study period, from dissection with a balloon dissector to without it. RESULTS: Of 128 cases, 57 belonged to the balloon dissection group and the other 71 belonged to the plain dissection group. The demographic features and clinical characteristics were similar in both groups. Mean operation time (57.7 vs. 45.6 min, p<0.001) and laparoscopic recording time (31.6 vs. 25.0 min, p=0.004) were significantly shorter in the plain dissection group without differences in the degree of bloodstaining and the frequency of peritoneal tearing. Postoperative complications did not differ between the two groups. CONCLUSION: Plain dissection may be a safe and feasible alternative method of achieving the preperitoneal space in TEP by an experienced surgeon.
Hernia, Inguinal* ; Humans ; Postoperative Complications ; Retrospective Studies ; Video Recording

Paraesophageal hernia comprises only 2 approximately 5% of all hiata hernias but is prone to incarceration and strangulation. For this reason they must be recognized and repaired as expeditiously as possible. The laparoscopic approach has already been successfully applied to the repair of the more common sliding hiatal hernia and it seems reasonable to propose that the paraesophageal hernia, provided it is not complicated, might also be repaired by the laparoscopic technique. We present here a case of paraesophageal hernia which has been successfully repaired by the laparoscopic approach. A 73-year-old female suffering from postprandial fullness in the retrosternal area was diagnosed preoperatively with paraesophageal hiatal hernia with gastroesophageal acid reflux and was submitted for laparoscopic repair. The procedure entailed reduction of the hernia, mobilization of the esophagogastric junction with crural repair and partial fundoplication. At the 9th-month follow-up, the patient had remained asymptomatic and follow-up studies revealed no evidence of hernia or acid reflux. As a result of this favorable experience with minimal morbidity, early hospital discharge, and effective control of symptoms without adverse sequalae, laparoscopic repair can be considered as the curative and minimal invasive method in the management of paraesophageal hernia.
Aged ; Case Report ; Female ; Hernia, Hiatal/complications/*surgery ; Human ; Laparoscopy

Direct suture repair with mesh reinforcement is the main surgical procedure in ventral hernia repair. The best place for mesh implantation is retromuscular space which means sublay. The most commonly used techniques are open sublay and laparoscopic IPOM repair. But open sublay repair may cause more trauma to the abdominal wall and result in more infections. Laparoscopic IPOM repair carries an increased risk in bowel injury, mesh-related complications and postoperative pain. Germany surgeon Reinpold developed a new technique defined as "MILOS concept" by combining the advantages of open sublay and laparoscopic IPOM repair. This technique uses mini or less incision hybrid with endoscopic technique to accomplish minimally invasive sublay repair. The MILOS operation has the advantages of less operative trauma, fewer postoperative complications, low recurrence rate and high economic efficiency. "MILOS concept" has been applied with several modifications by using endoscopic technique (EMILOS and eTEP) or robotic surgery. This new minimal invasive ventral hernia repair technique is accepted and applied in clinical practice by most surgeons worldwide. Several literatures already reported that this procedure had very good surgical outcomes, and confirmed its value in further popularization.
Hernia, Ventral ; surgery ; Herniorrhaphy ; Humans ; Laparoscopy ; Postoperative Complications ; Surgical Mesh

PURPOSE: In the early 1990's laparoscopic hernioplasty gained popularity worldwide. Thereafter, laparoscopic surgeons have attempted to improve cosmesis using single port surgery. This study aims to introduce and assess the safety and feasibility of single port laparoscopic total extraperitoneal (TEP) hernia repair with a nearly-scarless umbilical incision. METHODS: Sixty three single port laparoscopic TEP hernia repairs were performed in sixty patients from June 2010 to March 2011 at Incheon St. Mary's Hospital, with the use of a glove single-port device and standard laparoscopic instruments. Demographic and clinical data, intraoperative findings, and postoperative course were reviewed. RESULTS: Of the 63 hernias treated, 31 were right inguinal hernias, 26 were left inguinal hernias and 3 were both inguinal hernias. There was one conversion to conventional three port laparoscopic transabdominal preperitoneal hernioplasty. Mean operative time was 62 minutes (range, 32 to 150 minutes). There were no intraoperative complications. Postoperative complications occurred in two cases (wound seroma and urinary retension) and were successfully treated conservatively. Mean hospital stay was 2.15 days. CONCLUSION: Single port laparoscopic TEP hernia repair is safe and feasible. Umbilical incision provides an excellent cosmetic outcome. Prospective randomized studies comparing single port and conventional three port laparoscopic TEP repairs with short-term outcome and long-term recurrence rate are needed for confirmation.
Cosmetics ; Hernia ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Intraoperative Complications ; Length of Stay ; Operative Time ; Postoperative Complications ; Pyrazines ; Recurrence ; Seroma

PURPOSE: In the early 1990's laparoscopic hernioplasty gained popularity worldwide. Thereafter, laparoscopic surgeons have attempted to improve cosmesis using single port surgery. This study aims to introduce and assess the safety and feasibility of single port laparoscopic total extraperitoneal (TEP) hernia repair with a nearly-scarless umbilical incision. METHODS: Sixty three single port laparoscopic TEP hernia repairs were performed in sixty patients from June 2010 to March 2011 at Incheon St. Mary's Hospital, with the use of a glove single-port device and standard laparoscopic instruments. Demographic and clinical data, intraoperative findings, and postoperative course were reviewed. RESULTS: Of the 63 hernias treated, 31 were right inguinal hernias, 26 were left inguinal hernias and 3 were both inguinal hernias. There was one conversion to conventional three port laparoscopic transabdominal preperitoneal hernioplasty. Mean operative time was 62 minutes (range, 32 to 150 minutes). There were no intraoperative complications. Postoperative complications occurred in two cases (wound seroma and urinary retension) and were successfully treated conservatively. Mean hospital stay was 2.15 days. CONCLUSION: Single port laparoscopic TEP hernia repair is safe and feasible. Umbilical incision provides an excellent cosmetic outcome. Prospective randomized studies comparing single port and conventional three port laparoscopic TEP repairs with short-term outcome and long-term recurrence rate are needed for confirmation.
Cosmetics ; Hernia ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Intraoperative Complications ; Length of Stay ; Operative Time ; Postoperative Complications ; Pyrazines ; Recurrence ; Seroma

Adult ; Aged ; Body Constitution ; Female ; Hernia ; complications ; Hernia, Obturator ; complications ; surgery ; Herniorrhaphy ; Humans ; Intestinal Obstruction ; etiology ; surgery ; Male ; Middle Aged