Transabdominal preperitoneal laparoscopic inguinal herniorrhaphy: assessment of initial experience

To evaluate our initial experience with laparoscopic inguinal herniorrhaphy.

We retrospectively studied a consecutive series of patients selectively chosen for laparoscopic repair of inguinal hernia.

The study cohort consisted of 173 patients treated by a single surgeon between 1992 and 1995. For all operations, a transabdominal approach was used. Follow-up was obtained by telephone contact or letter.

The study group consisted of 167 male and 6 female patients with a mean age at operation of 55 years (range, 15 to 81). During the study period, 206 laparoscopic inguinal hernia repairs were performed in the 173 patients. Only one patient (0.6%) required conversion to laparotomy. Bilateral hernia repair was done in 31 patients (18%). Of the 206 procedures, 63 repairs (31%) were performed for recurrent hernias. In 69% of the patients, the procedure was completed on an outpatient basis. Early postoperative complications necessitating surgical intervention occurred in four patients. The median time to return to work or normal physical activity was 7 days for unilateral and 12 days for bilateral hernia repair (P = 0.18). A mean follow-up of 29 months was obtained for 171 patients (99%). In six patients (3%), a recurrent hernia developed. Four of these six patients had previously undergone an open surgical procedure on the side of the recurrence.

Laparoscopic inguinal herniorrhaphy is a feasible alternative to open hernia repair. This operation, however, should be reserved for selected patients. Longer follow-up and controlled trials comparing laparoscopic and tension-free open herniorrhaphy are necessary for assessment of the relative benefits of this procedure.