Laparoscopic herniorrhaphy in the geriatric population

Laparoscopy has brought controversy to herniorrhaphy, particularly in the elderly. We reviewed our experience with this technique in patients older than 65 years at a single teaching institution. Data include demographics, American Society of Anesthesiologists (ASA) class, operative time, hernia type, type of repair, hospital stay, and complications. A telephone questionnaire was used to assess return to normal activity, recurrence, and reason for choosing the laparoscopic approach. From March 1992 through March 1996, 110 of 328 patients were eligible. Mean age was 73 +/- 5.6 years; 34 patients had bilateral and 20 had recurrent hernias; 73 patients (66.4%) were ASA-2, and 22 (20%) were ASA-3. The extra-abdominal and transabdominal preperitoneal approaches were used in 64 and 46 patients, respectively; mean operative time was 87.9 +/- 34 minutes. The overall complication rate was 15 per cent, with 71 per cent of these being urinary retention. Patients were discharged the same day (59%) and at 1 day (33%). Follow-up was available in 84.5 per cent. Recurrence rate was 9.7 per cent, which was not significantly influenced by complication rate, hernia repair type, or ASA class. Median return to normal activity was 7 days. ASA classification correlated with hospital stay (P = .02), but not with complications, recurrence, or return to normal activities (P = not significant). Laparoscopic herniorrhaphy appears safe in the elderly.