Abstracts
1997 Digestive Disease Week

Prospective evaluation of the giant prosthetic reinforcement of the visceral sac (Stoppa procedure) for complex bilateral and recurrent inguinal hernias.

CC Solorzano§, JW Kilkenny*, OJ Cicilioni§, JN Vauthey§. Department of Surgery, University of Florida College of Medicine, §Gainesville and *Jacksonville*, FL.

Background: Complex bilateral and recurrent inguinal hernias are associated with a high recurrence rate. Methods: This study evaluates prospectively the efficacy and safety of giant prosthetic reinforcement of the visceral sac (GPRVS) in a group of patients at high risk for recurrence. Results: Sixty-four patients with 125 inguinal hernias (61 bilateral and 3 unilateral) underwent repair using a large polyester mesh based on Stoppa's preperitoneal technique. Mean age was 60 years (range 31-87), 63 were men and 65% had one or more co-morbid medical conditions. Factors predicating a high risk for recurrence included: large hernia size (>=5cm) 33% (21/64), failure of one or more previous repairs 38% (24/64), age >=60 years 53% (34/64), chronic obstructive pulmonary disease 23% (15/64), and associated non-inguinal lower abdominal hernias 9% (6/64). Mean operative time was 114 min (45-235). General anesthesia was used in 84% (54/64) and spinal in 16% (10/64). Mean length of stay was 3±3 days (range 1-20). There were 2 major (one pneumonia. one retroperitoneal hematoma) and 17 minor complications (6 superficial wound infections, 4 urinary retentions, 3 ileus, and 2 subcutaneous hematomas). There were no mesh infections or deaths. Follow-up was obtained in 95% (61/64). Subjective pain was 4±2 (range 1-10, 10 being worst pain) as compared to prior repairs 7 ±2 (4-10) for patients who had recurrent hernias. There was no chronic neuralgia. After a mean follow-up of 16±10 months, the recurrence rate was 0.8% (1/125). Conclusion: GPRVS is a safe, effective operation well suited for the repair of complex bilateral or recurrent inguinal hernias.