Pseudo-recurrence following laparoscopic ventral and incisional hernia repair.

ABSTRACT

PURPOSE: Laparoscopic mesh repair is an established alternative to the open repair of herniae of the antero-lateral abdominal wall. However, a definition in the literature of "recurrence" is lacking. This study reviews the phenomenon of pseudo-recurrence in patients who describe recurrent symptoms despite an apparently successful laparoscopic ventral or incisional hernia repair (LVIHR). METHODS: Cases of LVIHR from 1st January 2004 to 31st December 2007 were identified from the Lothian Surgical Audit database. Patients were contacted by telephone after a minimum of 11 months following operation. Pseudo-recurrences were identified by history and clinical examination, together with radiological investigation if the diagnosis remained in doubt. RESULTS: One hundred and forty-three repairs were performed in the study period. One hundred and twenty-one patients were contacted (63 incisional and 58 other ventral herniae). Twenty possible recurrences were reported (16.5%). Four were true recurrences and two more were new incisional herniae. There were 14 pseudo-recurrences, arising after 12 incisional and two other ventral hernia repairs. These were due to mesh bulge (10), seroma (3) and retained hernia contents (1). CONCLUSION: True recurrences after LVIHR do occur but should be preventable with good surgical technique. Pseudo-recurrences are more common and may mimic true recurrence. We recommend computed tomography (CT) to clarify the diagnosis and determine the indication for revisional surgery.