Abstract
Background
Despite numerous attempts to improve the techniques used for hernia repair, current published series show that recurrence rates are as high as 5–20%. The complexity of inguinal anatomy, combined with multiple potential areas of weakness, has contributed to the difficulty in preventing recurrences. However, the laparoscopic approach to inguinal herniorrhaphy has allowed clear visualization of all preperitoneal fascial planes and anatomic landmarks, as well as the hernia defect(s) and the peritoneal reflection. In the course of our performance of a series of 1,224 laparoscopic inguinal hernia repairs, we have developed a total extraperitoneal approach that yields excellent results with a low initial recurrence rate. Herein we describe our experience.
Methods
After our initial 300 transabdominal preperitoneal (TAPP) hernia repairs, which resulted in six recurrences, two bowel injuries, one bladder injury, and six cutaneous nerve injuries, the total extraperitoneal approach (TEP) was adopted.
Results
The first 300 TEP repairs resulted in one recurrence, two bowel injuries, one bladder injury, and two cutaneous nerve injuries. All major complications occurred in patients who had had previous lower abdominal surgery. In the last 624 TEP herniorrhaphies we implemented some modifications to the technique, especially for patients with previous lower abdominal surgery. In this group we recorded one bladder injury, no cutaneous nerve injuries, and one recurrence.
Conclusions
The total extraperitoneal approach for laparoscopic herniorrhaphy allows for a safe and effective repair with low rates of complication and recurrence. A thorough knowledge of the anatomy of the extraperitoneal space and especially the two- and three-dimensional inguinal anatomy of this space contributed greatly to the evolution of our technique.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Amid PK, Shulman AG, Lichtenstein IL (1993) Current state of the Lichtenstein open tension-free hernioplasy: does laparoscopic hernia repair measure up? Contemp Surg 43: 229–233
Beets GL, Oosterhuis KJ, Go PMNYH, Baeten CGMI, Kootstra G (1997) Long-term follow-up (12–15 years) of a randomized controlled trial comparing Bassini-Stetten, Shouldice, and high ligation with narrowing of the internal ring for primary inguinal hernia repair. J Am Coll Surg 185: 352–357
Bendavid R (1988) New techniques in hernia repairs. World J Surg 13: 522–531
Eubanks S, Newmann III L, Geohring L, Lucas GW, Adams CP, Mason EM, Duncan TD (1993) Meralgia paresthetica: a complication of laparoscopic herniorrhaphy. Surg Endosc 3: 381–385
Felix E, Scott S, Crafton B, Geis P, Duncan T, Sewell R, McKernan B (1998) Causes of recurrence after laparoscopic hermioplasty: a multicenter study. Surg Endosc 12: 226–231
Ferzli G, Massaad A, Albert P, Worth MH (1993) Endoscopic extraperitoneal herniorrhaphy versus conventional hernia repair: a comparative study. Curr Surg 50: 291–293
RJ, Fitzgibbons PK, Amid JD, Corbitt JB, McKernan LM, Nyhus JH, Payne Jr. Symposium: operative repair of inguinal hernias—part 1. Contemp Surg 51: 387–397 (1997)
RJ, Fitzgibbons PK, Amid JD, Corbitt JB, McKernan LM, Nyhus JH, Payne Jr. Symposium: operative repair of inguinal hernias—part 2. Contemp Surg 52: 61–76 (1997)
Heikkinen TJ, Haukipuro K, Hulkko A (1998) A cost and outcome comparison between laparoscopic and Lichtenstein hernia operations in a day-case unit: a randomized prospective study. Surg Endosc 12: 1199–1203
Kald A, Anderberg B, Carlsson P, Park PO, Smedh K (1997) Surgical outcome and cost-minimisation analysis of laparoscopic and open hernia repair: a randomised prospective trial with one-year follow-up. Eur J Surg 163: 505–510
Liem MSL, Van Der Graaf Y, Van Steensel CJ, Boelhouwer RU, Clevers GJ, Meijer WS, Stassen LPS, Vente JP, Weidema WF, Schrijvers AJP, Van Vroonhoven TJMV (1997) Comparison of conventional anterior surgery and laparoscopic surgery for inguinal hernia repair. New Engl J Med 336: 1541–1547
Paganini AM, Lezoche E, Carle F, Favretti F, Feliciotti F, Gesuita R, Guerrieri M, Lomanto D, Nordovino M, Panti M, Ribichini P, Sarli L, Sottili M, Tamburini A, Taschieri A (1998) A randomised, controlled, clinical study of laparoscopic versus open tension-free inguinal hernia repair. Surg Endosc 12: 979–986
Payne Jr JH, Grininger LM, Izawa MT, Podoll EF, Lindahl PJ, Balfour J (1994) Laparoscopic or open inguinal, herniorrhaphy? a randomized prospective trial. Arch Surg 129: 973–981
Phillips EH, Rosenthal R, Fallas M, Carroll B, Arregui M, Corrbitt J, Fitzgibbons R, Seid A, Schultz L, Toy F, Wadell R, McKernan B (1995) Reasons for early recurrence following laparoscopic hernioplasty. Surg Endosc 9: 140–145
Phillips EH, Arregui M, Carroll BJ, Corbitt J, Crafton WB, Fallas MJ, Filipi C, Fitzgibbons RJ, Franklin MJ, McKernan B, Olsen D, Ortega A, Payne Jr. JH, Peters J, Rodriguez R, Rosette P, Schultz L, Seid A, Sewell R, Smoot R, Toy F, Waddell R, Watson S (1995) Incidence of complications following laparoscopic hernioplasty. Surg Endosc 9: 16–21
Ramshaw BJ, Tucker JG, Conner T, Mason EM, Duncan TD, Lucas GW (1996) A comparison of the approaches to laparoscopic herniorrhaphy. Surg Endosc 10: 29–32
Ramshaw BJ, Tucker JG, Duncan TD, Heithold D, Garcha I, Mason EM, Wilson JP, Lucas GW (1996) The effect of previous lower abdominal surgery on performing the total extraperitoneal approach to laparoscopic herniorrhaphy. Am Surg 62: 292–294
Schuricht AL, McCarthy CS, Wells WL, Kumor RJ, Cwik J (1997) A comparison of epidural versus general anesthesia for outpatient endoscopic preperitoneal herniorrhaphy. JSLS 1: 141–144
Stoker DL, Spiegelhalter DJ, Singh R, Wellwood JM (1994) Laparoscopic versus open inguinal hernia repair: randomised prospective trial. Lancet 343: 1243–1245
Robbins AW, Rutkow IM (1993) The mesh-plug hernioplasty. Surg Clin North Am 73: 501–512
Wantz GE (1984) Complications of inguinal hernia repair. Surg Clin North Am 64: 287–298
Wantz GE (1998) Hernioplasty controversy. J Am Coll Surg 3: 372–373
Wellwood J, Sculpher MJ, Stoker D, Nicholls GJ, Geddes C, Whitehead A, Singh R, Spiegelhalter DJ (1998) Randomised trial of laparoscopic versus open mesh repair for inguinal hernia: outcome and cost. Br Med J 317: 103–109
Welsh DRJ, Alexander MAJ (1993) The Shouldice repair. Surg Clin North Am 73: 451–469
Wright DM, Kennedy A, Baxter JN, Fullarton GM, Fife LM, Sunderland GT, O’Dwyer PJ (1996) Early outcome after open versus extraperitoneal endoscopic tension-free hernioplasty: a randomized clinical trial. Surgery 119: 552–557
Author information
Authors and Affiliations
Additional information
Online publication: 28 September 2000
Rights and permissions
About this article
Cite this article
Ramshaw, B., Shuler, F.W., Jones, H.B. et al. Laparoscopic inguinal hernia repair. Surg Endosc 15, 50–54 (2001). https://doi.org/10.1007/s004640001016
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s004640001016