>Year 2004, Issue 4
Inguinal hernia recurrence. What does it mean? Is it a semantic problem? Is it a language and interpretation problem? Is it the error of the millennium?
Cir Gen 2004; 26 (4)
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Objective: To demonstrate that the term “recurrence” is wrongly applied in the inguinocrural area in relation to the type of hernia according to the existing classifications; to propose a universal definition and criterion to denominate the real recurrence of inguinocrural hernia.
Setting: Private health care institution.
Design: Descriptive and observational study without control group. An interview with 15 questions was applied to 70 surgeons that perform inguinal hernioplasties, 55 Mexican surgeons and 15 members of the American Hernia Society (AHS) of different nationalities. We include the observations obtained from 96 patients re-operated from June 2001 to May 2004, with a diagnosis of “recurring” inguinal hernia and compared the operative findings of the surgical re-intervention with those of the primary surgery.
Results: 100% of the interviewed were unable to provide a concrete definition of recurrence. There were divergences in opinions between the AHS members, but the non-members (85%) agreed with the definition given in the conclusion, accepting that the three types of inguinal hernias are totally different. Fifty two percent did not accept that the femoral orifice belongs to the inguinal area; 80% accepted that most “recurrences” reappear as direct defects after repair without a mesh. Seventy five percent considered it mandatory that the defect must reappear in the same specific anatomic site of the primary hernia to be called recurrent. From the 96 re-operated patients, 81 had indirect hernia, eight a direct one, in seven patients the type of primary hernia was not known. During re-intervention, we found 84 direct defects, 5 indirect, and 7 mixed defects.
Conclusion: There is no formal consensus concept of recurrence in inguinocrural hernia. I propose to establish a universal definition and criterion to denominate a recurrence as such. Recurrence is: that hernia that reappears at the same specific anatomic site after a temporal surgical disappearance and that is classifiable as primary hernia”.
||Inguinal area, inguinal hernia, recurrence classification.
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>Year 2004, Issue 4