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PubMed · 9927988

Classification systems and groin hernias.

I M Rutkow·A W Robbins
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Abstract

The once simple division of groin hernias into indirect and direct inguinal and femoral components is no longer adequate to reflect a more sophisticated understanding of the pathophysiology and management of these lesions. Similarly, the availability of a concise, easy-to-use, logical, and recognizable classification scheme would facilitate a better understanding of modern repair techniques and confirmation of operative results.

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Hernia, InguinalHumansPatient SelectionRecurrenceSeverity of Illness IndexSurgical MeshTreatment OutcomeJournal ArticleReview

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I M Rutkow, A W Robbins. 1998. Classification systems and groin hernias.. https://doi.org/10.1016/s0039-6109(05)70373-x

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PubMed2006

Treating recurrence after a totally extraperitoneal approach.

BACKGROUND: One of today's most highly regarded procedures for treating inguinal hernia is the totally extraperitoneal approach (TEP), but it can on occasion lead to recurrence. This is commonly managed with an open repair, a transabdominal preperitoneal procedure (TAPP), or another TEP. We report here on our years of experience with the latter. METHODS: The endeavor to a secondary TEP is much the same as to a primary one, but certain differences are encountered as the operation proceeds. For example, many anatomical landmarks found in a first TEP cannot be seen in a second. There can also be a diminished amount of working space, and this occasionally leads to an open conversion. RESULTS: From September 1991 to September 2005, we repaired 1,526 hernias in 1,156 male patients, using the TEP in every case. Of these, 21 were TEPs after a previous TEP. In 3 cases, the space could not be opened, and they were converted to the open Lichtenstein. One patient had peritoneal tears that led to conversion and another had conversion because of excessive bleeding. There were no complications, no bladder or bowel injuries, no transfusions, no preperitoneal hematomas, and no fatalities. All patients were discharged the same day. CONCLUSIONS: A secondary TEP, open repair, and TAPP are alternative solutions to the problem of recurrence after TEP. However, any TEP involves a very prolonged learning curve for general surgeons, since they must learn the anatomy as well as the procedure, both at the same time. This is doubly true for the TEP after a previous TEP.

Hernia, Inguinal↗