Critical appraisal and current position of laparoscopic hernia repair

Laparoscopic hernia repair is still undergoing development and appraisal. This review briefly outlines the history of hernia repair. The six techniques of laparoscopic repair are described and published experience for each of these is discussed. The techniques, which involve simple closure of the neck of the hernial sac with or without closure of the internal ring, appear to have little or no place in adult practice. The plug technique and plug and patch technique represented a transient phase of development and have now been abandoned. Suture techniques have not been widely practised, making current appraisal difficult. Of the mesh techniques the intraperitoneal onlay mesh technique is not recommended. The place of the transabdominal preperitoneal technique and the extraperitoneal technique need to be determined by prospective randomized clinical trials.