[Management of recurrent XXXX after previous mesh repair: a challenge].

@entity1 @entity158 @entity547 @entity169 @entity1118
INTRODUCTION: Since the use of prosthetic mesh for the surgical repair of @entity169 has become increasingly popular, mesh material introduced during a previous operation is being detected in a growing number of @entity1 undergoing surgery for recurrent @entity547 . This applies to at least 10% of recurrences. Needed is a therapeutic algorithm for the surgical management of recurrent @entity547 after previous mesh repair. MATERIAL AND METHODS: A total of 672 recurrent @entity547 repairs performed in hospitals in the German cities Aachen and Koblenz were analysed in order to review clinical practice. In 92 @entity1 (13.7%) who underwent surgery for recurrent @entity547 , mesh had been used in the previous @entity547 repairs. Attention was focused on the location of the recurrence in relation to the site of mesh implantation and on the advantages and disadvantages of the various surgical procedures for repairing recurrent @entity547 . Re-examination was performed with a mean follow-up of 3 years. RESULTS: Surgeons mostly decided during operation which procedure to use. A transinguinal approach was preferred for @entity1 presenting with recurrent @entity547 and @entity158 , and mesh material introduced during a previous operation was then explanted. In the case of multiple recurrences, a minimal direct suture repair was used for small defects or a preperitoneal approach for inserting a new, large mesh. The majority of recurrences were medial or suprapubic, especially those occurring after a Lichtenstein repair. After re-examining 87 of 92 @entity1 , nine recurrences (10.3%) were found. Mesh-free suturing methods were affected most frequently. Moderate complaints were reported by 39.1%, and 4.6% suffered from medical @entity1118 . CONCLUSION: The surgical management of recurrent @entity547 after previous mesh repair is a particular challenge for surgeons. We introduce a therapeutic algorithm for recurrent @entity547 surgery after previous mesh implantation based on analysis of clinical practice.
