Abstract：
This study aims to characterize the patterns of recurrence associated with specific types of primary inguinal hernia repair techniques used for and their respective correlations with early morbidity, in patients undergoing open repair for their first hernia recurrence.
After ethics approval was obtained, a retrospective review of charts from patients who underwent open surgery for repair of a first recurrence after a previous inguinal hernia repair during 2013-2017 was completed. Statistical analyses were performed and p-values < .05 are reported as statistically significant.
1393 patients underwent 1453 surgeries for recurrent inguinal hernias at this institution. Operations for recurrence were longer (61.9 ± 21.1 vs. 49.3 ± 11.9; p < .001), required more frequent intra-operative surgical consultation (1% vs. 0.2%; p < .001) and had a higher incidence of surgical-site infections (0.8% vs. 0.4%; p = .03) than primary inguinal hernia repairs. When comparing the patterns of recurrence among different techniques of primary repairs, patients undergoing laparoscopic hernia repair presented with a higher incidence of indirect recurrences. Reoperations after a Shouldice repair and open mesh repair represented markers for higher surgical difficulty in the recurrent operation (longer operative time, higher identification of heavy scarring, less nerve identification, and higher frequency of intra-operative consultation), but not higher rates of complications when compared with other techniques.
Open reoperations for inguinal hernia first recurrences are more complex, with noticeable differences according to the index operation, and associated with higher morbidity when compared with primary hernia repairs. This complexity varies according to the type of primary surgery, with a previous Shouldice repair and open hernia repair with mesh presenting higher surgical difficulties although this did not translate to higher incidence of early complications. This information may allow adequate allocation of surgeons with an expertise in recurrent hernias and choice of recurrent repair method (laparoscopic or open) based on the primary surgery.
After ethics approval was obtained, a retrospective review of charts from patients who underwent open surgery for repair of a first recurrence after a previous inguinal hernia repair during 2013-2017 was completed. Statistical analyses were performed and p-values < .05 are reported as statistically significant.
1393 patients underwent 1453 surgeries for recurrent inguinal hernias at this institution. Operations for recurrence were longer (61.9 ± 21.1 vs. 49.3 ± 11.9; p < .001), required more frequent intra-operative surgical consultation (1% vs. 0.2%; p < .001) and had a higher incidence of surgical-site infections (0.8% vs. 0.4%; p = .03) than primary inguinal hernia repairs. When comparing the patterns of recurrence among different techniques of primary repairs, patients undergoing laparoscopic hernia repair presented with a higher incidence of indirect recurrences. Reoperations after a Shouldice repair and open mesh repair represented markers for higher surgical difficulty in the recurrent operation (longer operative time, higher identification of heavy scarring, less nerve identification, and higher frequency of intra-operative consultation), but not higher rates of complications when compared with other techniques.
Open reoperations for inguinal hernia first recurrences are more complex, with noticeable differences according to the index operation, and associated with higher morbidity when compared with primary hernia repairs. This complexity varies according to the type of primary surgery, with a previous Shouldice repair and open hernia repair with mesh presenting higher surgical difficulties although this did not translate to higher incidence of early complications. This information may allow adequate allocation of surgeons with an expertise in recurrent hernias and choice of recurrent repair method (laparoscopic or open) based on the primary surgery.
摘要：
目的：本研究旨在描述与特定类型的原发性腹股沟疝修补技术相关的复发模式及其与早期发病率的相关性，在接受开放修补术的患者中，他们的第一次疝气复发。
方法：获得伦理批准后，我们完成了对2013-2017年间曾接受腹股沟疝修补术后首次复发的开放手术患者的回顾性分析.进行统计分析,p值<0.05被报告为统计学上显著的。
结果：1393例患者在该机构接受了1453例复发性腹股沟疝手术。复发的手术时间更长（61.9±21.1vs.49.3±11.9；p<.001)，需要更频繁的术中手术会诊(1%与0.2%；p<.001），手术部位感染的发生率较高（0.8%vs.0.4%；p=0.03）比原发性腹股沟疝修补术。当比较不同修复技术之间的复发模式时，接受腹腔镜疝修补术的患者间接复发的发生率较高.Shouldice修复和开放网片修复后的再手术代表了复发性手术中手术难度较高的标记（手术时间较长，对重度疤痕的识别更高，较少的神经识别，术中咨询的频率更高)，但与其他技术相比，并发症的发生率并不高。
结论：腹股沟疝首次复发的开放再手术更为复杂，根据指数操作有明显的差异，与原发性疝修补术相比，发病率更高。这种复杂性根据初级手术的类型而有所不同，先前的Shouldice修补术和带网片的开放式疝修补术存在较高的手术难度，尽管这并没有转化为较高的早期并发症发生率。此信息可能允许适当分配具有复发性疝专业知识的外科医生，并根据初次手术选择复发性修复方法（腹腔镜或开腹）。
方法：获得伦理批准后，我们完成了对2013-2017年间曾接受腹股沟疝修补术后首次复发的开放手术患者的回顾性分析.进行统计分析,p值<0.05被报告为统计学上显著的。
结果：1393例患者在该机构接受了1453例复发性腹股沟疝手术。复发的手术时间更长（61.9±21.1vs.49.3±11.9；p<.001)，需要更频繁的术中手术会诊(1%与0.2%；p<.001），手术部位感染的发生率较高（0.8%vs.0.4%；p=0.03）比原发性腹股沟疝修补术。当比较不同修复技术之间的复发模式时，接受腹腔镜疝修补术的患者间接复发的发生率较高.Shouldice修复和开放网片修复后的再手术代表了复发性手术中手术难度较高的标记（手术时间较长，对重度疤痕的识别更高，较少的神经识别，术中咨询的频率更高)，但与其他技术相比，并发症的发生率并不高。
结论：腹股沟疝首次复发的开放再手术更为复杂，根据指数操作有明显的差异，与原发性疝修补术相比，发病率更高。这种复杂性根据初级手术的类型而有所不同，先前的Shouldice修补术和带网片的开放式疝修补术存在较高的手术难度，尽管这并没有转化为较高的早期并发症发生率。此信息可能允许适当分配具有复发性疝专业知识的外科医生，并根据初次手术选择复发性修复方法（腹腔镜或开腹）。
