Laparoscopic totally extraperitoneal inguinal hernia repair: lessons learned from 3,100 hernia repairs over 15 years
Two revolutions in inguinal hernia repair surgery have occurred during the last two decades. The first was the introduction of tension-free hernia repair by Liechtenstein in 1989 and the second was the application of laparoscopic surgery to the treatment of inguinal hernia in the early 1990s. The purposes of this study were to assess the safety and effectiveness of laparoscopic totally extraperitoneal (TEP) repair and to discuss the technical changes that we faced on the basis of our accumulative experience.
Patients who underwent an elective inguinal hernia repair at the Department of Abdominal Surgery at the Institute of Laparoscopic Surgery (ILS), Bordeaux, between June 1990 and May 2005 were enrolled retrospectively in this study. Patient demographic data, operative and postoperative course, and outpatient follow-up were studied.
A total of 3,100 hernia repairs were included in the study. The majority of the hernias were repaired by TEP technique; the repair was done by transabdominal preperitoneal (TAPP) repair in only 3%. Eleven percent of the hernias were recurrences after conventional repair. Mean operative time was 17 min in unilateral hernia and 24 min in bilateral hernia. There were 36 hernias (1.2%) that required conversion: 12 hernias were converted to open anterior Liechtenstein and 24 to laparoscopic TAPP technique. The incidence of intraoperative complications was low. Most of the patients were discharged at the second day of the surgery. The overall postoperative morbidity rate was 2.2%. The incidence of recurrence rate was 0.35%. The recurrence rate for the first 200 repairs was 2.5%, but it decreased to 0.47% for the subsequent 1,254 hernia repairs
According to our experience, in the hands of experienced laparoscopic surgeons, laparoscopic hernia repair seems to be the favored approach for most types of inguinal hernias. TEP is preferred over TAPP as the peritoneum is not violated and there are fewer intra-abdominal complications.
KeywordsInguinal hernia Totally extra peritoneal repair Laparoscopic repair 3-D mesh
- 1.Bassini E (1887) Sulla cura radicle dell’erinea inguinale. Arch Soc Ital Chir 4:380Google Scholar
- 3.Dulucq JL (1991) Traitement des hernies de l’aine par la mise en place d’un patch prothetique par laparoscopie. Voi totalement extraperitoneale. Cah Chir 79:15–16Google Scholar
- 4.Dulucq JL (2005) Tips and techniques in laparoscopic surgery (totally extraperitoneal approach for laparoscopic hernia repair). Springer-Verlag, BerlinGoogle Scholar
- 5.Rutkow IM (1998) Epidemiology, economic and sociologic aspects of hernia surgery in the United States in the 1990s. Surg Clin North Am 73:413–426Google Scholar
- 12.Sayad P, Ferzli G (1999) Laparoscopic preperitoneal repair of recurrent inguinal hernias. J Laparoendosc Adv Surg Tech A 9(2):127–130Google Scholar
- 17.Dulucq JL (1992) Treatment of inguinal hernias by insertion of mesh through retroperitoneoscopy. Post Graduate General Surg 4:173–174Google Scholar
- 18.Dulucq JL (2000) Pre-peritoneal approach in laparoscopic treatment of inguinal hernia. J Chir 137(5):285–288Google Scholar
- 25.Bowne WB, Morgenthal CB, Castro AE et al (2007) The role of endoscopic extraperitoneal herniorrhaphy: where do we stand in 2005? Surg Endosc 21(5):707–712Google Scholar