Preliminary evaluation of laparoscopic herniorrhaphy

Since November 1990, 50 laparoscopic herniorrhaphies have been done in 47 patients (three patients with bilateral repairs), including 31 indirect and 19 direct inguinal hernias, three of which were recurrent. The 47 patients included 42 men and five women. Small indirect hernias were treated by plugging the hernia orifice with a tightly rolled polypropylene mesh plug. Large indirect, all direct, and combined hernias were treated by creating a peritoneal flap and stapling a polypropylene mesh screen preperitoneally over the defect. The mesh was stapled to Cooper's ligament, iliopubic tract, and transversus abdominous arch. Forty-five patients were discharged on the day of surgery and the other two within 24 h. The average return to full activity has been two days. The only intraoperative complication was an easily controlled trocar site bleeder. Postoperatively one minor trocar site infection occurred. One persistent and one recurrent hernia were among the group, both large indirect hernias done early in our experience (by the plug technique) before stapling instruments were available. The technique of laparoscopic herniorrhaphy is in its infancy and still evolving as our understanding of anatomy and technology improves. Even if long-term follow-up shows an acceptable recurrence rate and less patient disability, surgeons must weigh the wisdom of converting a procedure from local to general anesthesia and an inexpensive procedure into a more expensive procedure.