A long-term follow-up of a single rural surgeon's experience with laparoscopic inguinal hernia repair

Inguinal hernia repair is one of the most common surgical procedures performed in the United States, with an estimated 700,000 or more completed annually.

This study looks at 7 years of laparoscopic totally extra-peritoneal (TEP) inguinal hernia repair at a rural Wisconsin medical center. The goal is to accurately measure recurrence rates and mechanisms of recurrences within a single professional's practice using a follow-up of no less than 2 years. A secondary goal was to record the percentage of patients with short-term and long-term complications.

Patients with laparoscopic TEP inguinal hernia repairs from 1997 through 2004 were seen in follow-up visits > or =2 years after their initial repair. Of a possible 165 patients, 100 (61%) participated, returning for a total of 141 (64%) follow-up exams. Follow-up range was 2-7 years, with a mean of 3.7 years. All repairs were completed using a single technique (TEP) by a single surgeon. Repair variables included mesh thickness, style of mesh to cord accommodation, and fixation technique. Study participants ranged from 16 to 88 years, with an average age of 65.9 years. A wide range of socioeconomic indicators were represented, including education, occupation, and household income. Five participants were female and 95 were male.

The primary study outcome was the identification of an accurate recurrence rate along with the mechanism of hernia recurrence. Patients with long-term groin pain (dysesthesia) and identification of short-term complications were also noted.

Between 2004 and 2007, 100 patients were seen for follow-up. None had symptomatic hernia recurrences. One recurrence was found at exam and confirmed with a herniogram and laparoscopic surgical exploration. Two additional patients, identified by exam and herniograms as having suspected recurrences, are awaiting surgical exploration. In the case of 1 recurrence, the mechanism appears to be partial migration of mesh from the placement area. Long-term groin dysesthesias (moderate or occasional) occurred in 2 patients or 1.4% of repairs. Spermatic cord hematoma (18% of repairs) was the most common short-term complication.

Laparoscopic TEP inguinal hernia repairs are effective and durable in a rural setting. An acceptable recurrence rate (0.7%-2.1%) may be related to mesh placement, completeness of dissection, and the small but real risk of mesh migration or displacement prior to healing fixation. Long-term pain complications are reasonably low.