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Laparoscopic inguinal hernia repair: a NICE operation.
A M Pullyblank1, L Carney, F Braddon
1Department of General Surgery, Frenchay Hospital, Bristol, UK.
Journal of the Royal College of Surgeons of Edinburgh
|October 5, 2002
Summary
Transabdominal preperitoneal (TEP) repair is a safe and effective laparoscopic technique for inguinal hernias, offering low morbidity and quick return to normal activities. This method is comparable to open repair in terms of operating time and recurrence rates.
Area of Science:
- Surgical innovation
- Minimally invasive surgery
- Hernia repair
Background:
- Published evidence comparing laparoscopic and open herniorraphy is controversial.
- NICE guidelines suggest open techniques for primary repairs and TEP for bilateral/recurrent cases in specialist settings.
Purpose of the Study:
- To evaluate the safety, efficacy, and patient outcomes of transabdominal preperitoneal (TEP) laparoscopic inguinal hernia repair.
- To compare TEP outcomes with traditional open repair methods.
Main Methods:
- A consecutive series of 224 patients undergoing 268 TEP repairs between 1996 and 2001.
- Analysis of operating time, complications, return to normal activity, return to employment, and recurrence rates.
Main Results:
- Median operating time was 30 minutes with only one conversion.
- 94% of patients could drive by postoperative day 3; median return to normal activity was 4 days.
- Median return to employment was 3 days for 82 patients, with a 1.4% recurrence rate (none since mesh anchoring technique modification).
Conclusions:
- TEP is a safe, effective, and easily learned laparoscopic technique for inguinal hernia repair with low morbidity.
- TEP facilitates an early return to full-time employment with comparable outcomes to open repair.
- The choice between open and laparoscopic repair should be a shared decision between patient and surgeon.