Nyhus technique in the repair of recurrent inguinal hernias: analysis of a series of 203 patients

Abstract

Introduction: The choice of a technique for the treatment of recurrent inguinocrural hernias is controversial due to the variability of approaches and technical options. We present the cases of recurrent inguinal hernia treated by Nyhus-type open preperitoneal technique. Method: Retrospective, observational and descriptive study of patients operated by Nyhus technique, between September 2015 and June 2018, diagnosed with recurrent inguinal hernia. The main variable under study was the recurrence of inguinocrural hernia. Secondary variables were: the characteristics of patients and hernia recurrence, surgical and anesthetic technique, post-surgical complications and follow-up. Results: 203 patients were operated, with a mean age of 65 years. The characteristics of the patients are: 194 men (95.5 %), 21 diabetics (10.4 %), 33 smokers (16.3 %), 18 COPD (8.9 %). The average body mass index was 26.2 and the location of hernia recurrence, lateral (69 %), medial (30 %), femoral (5 %) and combinations between both in 5 % (lateral and medial or with a hernia associated primary femoral). Multi-relapsed patients were intervened in 16.2 % (33 patients), of which 24 had required two operations prior to the Nyhus technique and 9 had 3 or more previous inguinal surgeries. The recurrence rate was 4.9 %. Follow-up (median 24 months) was complete in 96.6 % (196 patients). In our study, we found no statistically significant relationship between secondary variables and recurrence. Conclusion: The inguinal hernia recurrence seems to be a multifactorial process. The use of the preperitoneal space after an inguinocrural repair by surgical anterior approach facilitates surgery and reduces local complications.