Prosthetic Inguinal Hernia Repair Using a Laparoscopic Extraperitoneal Approach

The preperitoneal technique offers several advantages over conventional anterior approaches in the surgical repair of inguinal hernias: direct access to the posterior inguinal anatomy, clear visibility of all possible hernial defects, ability to circumvent scar tissue and intra-abdominal adhesions, and ease of effecting difficult repairs. A preperitoneal prosthetic procedure has been successfully used, performed laparoscopically, to repair 163 indirect, 163 direct, and one femoral inguinal defects. In the approach used, a piece of polypropylene mesh, placed extraperitoneally, is used to reinforce or replace the transversalis fascia. In only one of 197 patients (0.5%) was it necessary to convert to an open procedure; this patient had a severely incarcerated hernia. Almost all patients were discharged on the day of surgery, and all returned to normal activities within 7 days. There were few complications, and the recurrence rate in the series of 300 repairs was only 0.3%. One patient required a second procedure because of a retained indirect hernia. Based upon these results and the experience of others using a similar approach, the laparoscopic extraperitoneal prosthetic repair is advocated for patients with recurrent, as well as bilateral and complicated inguinal defects.