A comparative study of laparoscopic extraperitoneal and transabdominal preperitoneal herniorrhaphy

Laparoscopic minimally invasive surgical procedures are gaining popularity. Laparoscopic hernia repair is now less controversial and more readily acceptable, with at present numerous technical modifications described in an attempt to define the best procedure. Between November 1992 and February 1995, a nonrandomized trial of laparoscopic inguinal herniorrhaphy was performed on 115 patients with a total of 120 hernias. Of these 58 patients with 60 hernias underwent the transabdominal preperitoneal patch repair (TAPP) without plug and 57 patients with a total of 60 hernias were offered the extraperitoneal (EXTRA) approach using a distension balloon. The average operative time was 55 min for the TAPP and 50 min for the EXTRA procedure. The overall recurrence rate was 1.7% with a follow up of 1-27 months. The recurrence rate was 3.4% for the TAPP and none for the EXTRA approach. All patients returned to their normal activity within 1 week of discharge. Patients undergoing the EXTRA repair consumed less amount of narcotic analgesic than did the group undergoing the TAPP repair. Of the EXTRA group 58% did not require any analgesic, compared to 22% of the TAPP group (p < 05). There were no intraoperative complications. A total of 8 (6.9%) postoperative complications occurred in 115 patients. Four complications (6.9%) occurred in the TAPP procedure: 2 transient urinary retentions, 1 pulmonary edema, and 1 Richter's type hernia. Four (6.9%) complications occurred in the EXTRA procedure: 1 urinary retention, 2 abdominal wall ecchymoses, and 1 thoracic pain. Hospital stay was shorter for the EXTRA group: 57% were discharged the same day and 98% were discharged within 24 h of their operations for the EXTRA group compared to 10 and 84%, respectively, for the TAPP (p < 0.05). Laparoscopic extraperitoneal hernia repair can be accomplished with shorter hospitalization and less analgesic requirement than the TAPP repair. The overall incidence of complications, the recurrence rate, and the return to normal activity were not different between the two types of repair.