Stoppa operation for complex recurrent groin hernia: A ten-year experience

Repairs for complex recurrent hernia are associated with a high re-recurrence rate. To terminate this vicious cycle, a radical procedure such as Stoppa operation may be indicated, however, the safety and long-term effectiveness of this procedure for complex recurrences have not been demonstrated in Taiwanese patients. Demographic, preoperative, operative and yearly follow-up data were analyzed for 135 patients who were treated from 1988 to 1998 for complex recurrent groin hernias using Stoppa operation with modification. Preperitoneal exploration of the 176 sides of recurrence revealed direct recurrences (64%), indirect (32%) and femoral (3%) recurrences. Thirty percent of them had multiple defects. The average size of mesh used was 23±2 cm × 14.6±1.5 cm for bilateral and 10.2±1.9 cm × 12.2±2.3 cm for unilateral recurrences. A 2 cm reduction from the transverse dimension of mesh prothesis compared with the original Stoppa proctocol was found to be better for Taiwanese patients. Surgical complication rate was 10%, including acute myocardial infarction (1), scrotal hematoma(9), low abdominal discomfort (2) and peritoneal defects over the mesh (1). During follow-up of a mean duration of 5.5 years (range one to 11 years) with a 87% follow-up rate, re-recurrences were identified in two (2%). The results of this study demonstrate that Stoppa operation with our modification in mesh design provides very effective and safe treatment for complex recurrent groin hernias in Taiwanese.