The open preperitoneal approach to recurrent inguinal hernias in high-risk patients.

BACKGROUND: Whether it is an open anterior, laparoscopic, or open preperitoneal approach, we have no general consensus on the preferred approach to recurrent inguinal hernia repairs. Recent reevaluations of the previously described open preperitoneal approach have shown promising results. We critically evaluate our experience with this procedure in our high-risk patient population and compare the results to other useful techniques.

METHODS: We present a retrospective study of 48 consecutive patients with 49 recurrent inguinal hernias. All patients underwent an open preperitoneal approach using a Bard Kugel Patch supervised by the senior author. Complications and recurrences were evaluated with all patients returning to the clinic postoperatively.

RESULTS: Among the 49 (6%) hernia repairs, there were three recurrences. The overall complication rate was 8%, including postoperative hematoma requiring drainage (1), pain leading to the patch being removed (1), and postoperative urinary retention (2).

CONCLUSION: The open preperitoneal approach using the Bard Kugel Patch for recurrent inguinal hernias results in a low recurrence rate and an acceptable complication rate. It is the preferred approach at our institution.