# Redo TEP in recurrent inguinal hernia After TEP/TAPP: Outcomes and feasibility

## TL;DR

This study compares two surgical methods for recurrent inguinal hernias after prior endoscopic repair and finds the Lichtenstein technique may be more effective.

## Contribution

The study provides empirical evidence comparing ReTEP and Lichtenstein for recurrent hernias after TEP/TAPP, supporting a shift in surgical approach.

## Key findings

- No significant difference in complication rates between ReTEP and Lichtenstein.
- Lichtenstein showed better outcomes for pain and foreign body sensation.
- Second recurrences were more common after ReTEP.

## Abstract

The optimal management of recurrent inguinal hernia following previous laparoendoscopic repair lacks robust scientific evidence and varies across guidelines. Due to a paucity of data, the European Hernia Society currently recommends open anterior repair for the management of recurrent inguinal hernias after a previous laparoendoscopic repair, based solely on expert opinion. However, repeat endoscopic repair can yield favorable outcomes in experienced hands. This study aimed to compare patient outcomes between repeat endoscopic repair (ReTEP) and the Lichtenstein technique for recurrent hernias after initial TAPP or TEP.

Adult patients undergoing surgery for first recurrence after laparoendoscopic repair were included. Intra- and postoperative morbidity was analyzed retrospectively, and symptoms and quality of life were assessed prospectively using clinical and ultrasound examination, the Carolinas Comfort Scale (CCS), and the COMI (Core Outcome Measurement Index)-Hernia questionnaire.

Between January 2012 and March 2020, the center performed 48 ReTEPs and 45 Lichtenstein hernioplasties for the first recurrence of inguinal hernia after primary endoscopic surgery. Both groups were generally comparable in terms of age, BMI and intrinsic perioperative risk factors. The rate of conversion from ReTEP to Lichtenstein procedure was 27,3%, remained consistent over the years and showed no correlation with surgeon’s expertise. There were no statistically significant differences in the frequency and severity of complications between ReTEP and Lichtenstein. The Lichtenstein procedure was significantly superior in the categories “foreign body sensation” and “pain” assessed using the CCS and the second recurrencies were more frequently observed after ReTEP.

The findings support the expert suggestion of HerniaSurge group regarding the change of procedure for managing recurrent inguinal hernia following initial endoscopic surgery. In this case the Lichtenstein operation should be considered.