Laparoscopic herniorrhaphy: technical concerns in prevention of complications and early recurrence

Laparoscopic herniorrhaphy continues to gain popularity, but should be subjected to proper scrutiny before widespread acceptance. From 5/91 to 6/93, 290 transabdominal preperitoneal (TAPP) laparoscopic herniorrhaphies were performed on 244 adult patients at Georgia Baptist Medical Center. Procedures consisted of indirect (164), direct (73), femoral (5), obturator (7), and recurrent (41) hernia repairs, with a mean operative time of 81.2 minutes (range 30-193 min). The overall technical complication rate was 5.3% and includes lateral thigh paresthesias (6), inferior epigastric artery injury (4), enterotomy during adhesiolysis (1), bowel obstruction secondary to herniation through a lateral trocar site (1), and bladder injury (1). The recurrence rate is 1% (3/290), with a mean follow up of 11 months (range 2-27 months). The authors present herein a discussion of technical considerations in an attempt to help decrease complications and recurrence as others incorporate laparoscopic hernia repair into their surgical armamentarium.