Table 1 Patient demographic data, hernia characteristics, and operative features. The previous techniques used were the TAPP in three patients and TEP in two patients. All the recurrences were on the same side. One nevertheless patient previously had had one open and one laparoscopic hernia repairs due to rerecurrence (case 1). The mean interval between the first laparoscopic and the relaparoscopic repairs was 8 months (range, 1�C13 months). Technical problems such as insufficient mesh size, mesh migration, and insufficient fixation were the main factors contributing to recurrences. During the relaparoscopic repair, placement of a new mesh (with or without removal of the old mesh) and fixation were performed in all the patients.

In two cases with no previous mesh fixation (cases number 4 and 5), the old mesh remained on the peritoneal side during preperitoneal dissection in re-TEP repairs and this greatly facilitated surgical manipulation. The mean operative time was 93min (range, 45�C120min). There were no conversions or intraoperative complications in any of the cases. In order to remove the old mesh in one case with mesh shrinkage (case number 3), the inferior epigastric artery had to be ligated due to tight adhesions between the mesh and the artery. In this case, peritoneal tear also occurred; however, it did not obscure the operative field. All the patients were discharged from hospital on the first postoperative day. Seroma formation occurred in two patients (cases number 1 and 2). The sizes of the seroma, as predicted on physical exam, were approximately 5 �� 3cm and 4 �� 3cm in cases 1 and 2, respectively.

As a conservative management, both seromas were allowed to resolve by itself without necessitating needle aspiration or any other interventional procedures. The mean follow-up period was 17 months (range, 7�C24 months). During followup, no documented case of chronic groin pain, sexual dysfunction, mesh infection, or rerecurrence were encountered. 4. Discussion Today, conventional open inguinal hernia repair is the preferred method by most surgeons for the treatment of recurrences after previous laparoscopic repair and this concept is also supported by European Hernia Society [3]. However, a number of published studies have appeared in the literature addressing the use of relaparoscopic repair (TAPP or TEP) of recurrences after previous laparoscopic repair and their findings indicate that there is a place for relaparoscopic surgery in the treatment of such recurrences [4�C11].

van den Heuvel and Dwars [11] and Knook et al. [5] reported on 49 and 18 TAPP repairs for recurrences after previous TAPP or TEP, respectively, and concluded that the TAPP repair is safe and reliable for recurrences. Also, Ferzli et al. [9] reported on 20 cases and found that TEP repair of recurrent inguinal AV-951 hernia after a primary TEP repair is entirely feasible technically as well as entirely safe.