Small bowel obstruction: a morbid complication after laparoscopic herniorrhaphy

More than 500,000 inguinal herniorrhapies are performed each year in the United States. The traditional methods of hernia repair have demonstrated a low complication rate (< 1%). Recently, the success of laparoscopic cholecystectomy (complication rate < 2%) has generated enthusiasm for the application of laparoscopic techniques toward the management of other intra-abdominal pathologies. The initial reports concerning the efficacy and advantages of laparoscopic surgery are encouraging. However, the limited data available thus far precludes the answering of questions regarding perioperative morbidity. We present two cases of small bowel obstruction that occurred following uncomplicated laparoscopic herniorrhaphy. One occurred 2 weeks postoperatively and consisted of a herniation through the re-approximated peritoneum over the repair site. The second occurred 3 days postoperatively and was caused by herniation through a large (10 mm) trochar site. Surgical intervention involved exploratory laparotomy in the former and laparoscopic techniques in the latter. We suggest that the principles of solid abdominal closure are applicable to the relatively small peritoneal defects created during laparoscopic procedures. Additionally, awareness of this potential complication will aid in decreasing the morbidity of this and other laparoscopic surgeries.