Assessing risks, costs, and benefits of laparoscopic hernia repair

Laparoscopic inguinal herniorrhaphy (LIHR) was introduced with the following potential advantages: less postoperative discomfort and pain, reduced recovery time that allows earlier return to full activity, easier repair of a recurrent hernia, the ability to treat bilateral hernias concurrently, the performance of a simultaneous diagnostic laparoscopy, ligation of the hernia sac at the highest possible site, improved cosmesis, and decreased incidence of recurrence. Potential disadvantages include complications, such as bowel, bladder, and vascular injuries; potential adhesive complications at sites where the peritoneum has been breached or prosthetic material has been placed; the apparent need, at least at the present, for a general anesthetic; and the increased cost because of expensive equipment needs. Most surgeons agree that LIHR has a role in the management of patients with a recurrent hernia after a conventional inguinal herniorrhaphy (CIHR), bilateral inguinal hernia, or a need for laparoscopy for another procedure, such as laparoscopic cholecystectomy. The routine use of LIHR for the unilateral, uncomplicated hernia is a more contentious issue.