Clinical study on Causes of Recurrence of Hernia after Mesh plug Tension-free Inguinal Hernioplasty and Methods of Reoperation

Objective To investigate the causes of groin hernia recurrence after mesh plug tension-free hernioplasty and study the reoperative strategies.Methods To retrospectively analyze the clinical data of 23 patients with recurrent groin hernia after mesh plug tension-free hernioplasty received operative treatment in our hospital from Octerber 2001 to Octerber 2008, All patients were diagnosed as indirect hernia during the first operation. Of them, 2 cases belonged to type Ⅱ, 16 to type Ⅲ and 5 to type Ⅳ. Recurrent patients were readmitted as 13 with indirect inguinal hernia and 8 with direct inguinal hernia.The average time of recurrence was 11 months ranged from 6 days to 28 months. The methods of reoperation were still open operation of tension-free inguinal hernioplasty.Results The mesh plug slid off the internal ring in 8 cases, herniary contents extruded from the internal ring along the mesh plug in 3 cases,herniary contents extruded between the two Mesh Plug in 2 cases, sac extruded below the too high-positioned Bard mesh in 3 cases, sac extruded below the coiled and/or dislocated Bard mesh in 5 cases, and the cause was not found in 2 cases. 23 cases all treated with tension-free hernioplasty again, and no postoperative recurrence was found after 6 to 60 months follow-up. Conclusion The main causes of groin hernia recurrence after mesh plug tension-free hernioplasty are related to age, high intra-abdominal pressure, methods of operation and improper choice of materials. With selection of proper operative methods and materials, the outcome of groin hernia recurrence after mesh plug tension-free hernioplasty treated with tension-free hernioplasty again still satisfactory.