[Laparoscopic hernia repair: prevention and therapy of complications]

Following the surgical steps in laparoscopic (transperitoneal) hernia repair, the corresponding groups of complications relate to: (1) laparoscopy; (2) the trocars; (3) the dissection of the inguinal region; (4) the hernia sac dissection; (5) the mesh placement; (6) the peritoneal closure. Inadequate surgical technique can lead to injuries of the intestine, urinary bladder and blood vessels; peri- and postoperative bleeding and hematoma; severing of testicular blood vessels, with consecutive testicular atrophy; and nerve lesions when fixing the mesh with clips and intestinal obstruction subsequent to insufficient peritoneal closure. With an adequate surgical technique, complication rate is very low. Preconditions for this are: strict compliance with the safety tests, when establishing the pneumoperitoneum; application of blunt conical trocars; precise knowledge of the anatomy; gentle dissection in the avascular tissue layers; subtle hemostasis; absolutely no diffuse electrocoagulation or placement of any clips below or up to 1 cm above the ileopubic tract; and safe peritoneal closure by suture under reduced intraabdominal pressure.