It’s Time to Change the Guidelines for Recurrent Inguinal Hernia After Posterior Repair, Re Posterior Tep Approach

Abstract The guidelines are that a Recurrent Open hernia should be repaired by a Posterior approach. While recurrent Posterior is recommended to be repaired with an Open anterior approach. We'd like to discuss the recommendation and present our data for TEP repair of recurrent LAP hernia. Since 2016, we have operated on 934 patients with Groin Hernias, 130 had a Recurrent Hernia, of which 33 was after LAP, 14 after TAPP and 19 after TEP. We started with TAPP, but quickly switched to TEP that allows the separation of all the mesh that was left attached to the peritoneum. We learned to begin separating the mesh from the lateral to medial. The surgery lasted longer, but there was no conversion to Open. The recovery after surgeries were regular and there was no recurrence. We switched to absorbable takers and glue for avoiding pain. There're significant advantages of TEP approach to repair a recurrent Posterior: 1. The edges of the mesh are not left exposed in the hernia defect in front of the bowel; 2. The mesh's removal completely from the posterior wall reducing pain; 3. Detecting defects that aren't visible in an Open. Repairing recurrent hernias requires skill and experience. In our opinion, there are advantages in repairing a recurrent Posterior hernia with the TEP approach, and we've shown that the repair can be performed safely and successfully. We suggest considering changing the guidelines and allowing surgeons to choose the approach they want to repair a recurrent Posterior hernia. More data should be collected.