Feasibility analysis of laparoscopic surgery with individualized patch for recurrent hernia with preperitoneal patch implantation

WANG Chen-xing; XUE Pei; LI Jian-wen; YUE Fei; FENG Bo; SONG Hai-qin; CHENG Xi; FU Zhan-wei

doi:10.19538/j.cjps.issn1005-2208.2025.05.14

Abstract：Objective To analyze the safety and effectiveness of applying tailored mesh in laparoscopic repair of recurrent hernia with preperitoneal mesh.Methods A retrospective analysis was performed based on the clinical data of 478 patients(515 hernias)with recurrent hernia who underwent laparoscopic inguinal hernia repair(LIHR)at Shanghai Ruijin Hospital between January 2011 and December 2024.Patients were grouped according to the type of previous surgery,with comparisons of clinical data and surgical outcomes among the following groups:high ligation(n=45),simple suture repair(n=203),Lichtenstein repair(n=89),mesh plug repair(n=81),and preperitoneal repair(including open preperitoneal repair and LIHR,n=60).Additionally,a total of 141 patients with recurrent hernia who had preperitoneal mesh were grouped by stage.The previous stage was from January 2011 to December 2017(80 cases),and the later stage was from January 2018 to December 2024(61 cases).Clinical data and surgical efficacy were compared across two stages to assess the clinical outcomes and efficacy of the tailored mesh technique.Results Except for high ligation repair,no significant differences were observed in the baseline data among groups after simple suture,Lichtenstein,mesh plug,preperitoneal(including open preperitoneal or LIHR)repair(P＞0.05).Compared with the no preperitoneal mesh group(including high ligation,simple suture and Lichtenstein repair),the recurrent hernia with preperitoneal mesh implanted(including mesh plug and preperitoneal repair)had a higher incidence of direct hernia recurrence,longer operation time,and longer postoperative hospital stay,with statistically significant differences(P＜0.05).A stratified analysis of recurrent hernias with preperitoneal mesh showed no significant differences in baseline data between the two stages(P＞0.05).However,the TAPP success rate(94.0％vs.91.1％,P=0.016),operation time[(50±12)min vs.(47±15)min,P=0.045],and postoperative hospital stay[(2.0±1.0)d vs.(1.7±1.5)d,P＜0.001)]in the later stage were all better than those in the previous stage,with statistically significant differences.Conclusion LIHR for recurrent hernias with preperitoneal mesh presents certain technical challenges.However,local repair technology with tailored mesh is safe,effective,and feasible.