A comparison of the approaches to laparoscopic herniorrhaphy

Abstract

Although both the transabdominal preperitoneal and total extraperitoneal approaches to laparoscopic herniorrhaphy have acceptable recurrence and complication rates, there were significant advantages to the total extraperitoneal approach in our institution. Previous lower abdominal surgery may be a relative contraindication to the total extraperitoneal approach.

Is inguinal hernia a defect in human evolution and would this insight improve concepts for methods of surgical repair?

“…Many series have been reported (Arregui et al, 1992;Kavic, 1993;Popp, 1993;Brown, 1994;Corbitt, 1994;Felix, 1994;Fernandez, 1994;Himpens et al, 1995;Khoury, 1995;Ramshaw et al, 1996), anatomic concepts discussed (Rosser, 1994;Colburn et al, 1995ab. ) and complications reported (MacFadyen et al, 1993;Spier et al, 1993;Kraus, 1994;Azurin et al, 1995;Petersen et al, 1995;Phillips et al, 1995;Takahara, 1995).…”

Laparoscopic Hernia Surgery:An Ov erview

“…They also state that socioeconomic aspects are the deciding factors in hernia surgery [3] (rather than the recurrence rate). Most of the published series were able to document that there is a steep learning curve for laparoscopic hernia repair (more for the TEP than for the TAPP procedure), and that the increased operating time could be seriously decreased [28, 62]. Use of nondisposable instruments and the two-trocar technique without mesh fixation (self-expandable meshes [62, 69] can further decrease the direct costs.…”

“…Most of the published series were able to document that there is a steep learning curve for laparoscopic hernia repair (more for the TEP than for the TAPP procedure), and that the increased operating time could be seriously decreased [28, 62]. Use of nondisposable instruments and the two-trocar technique without mesh fixation (self-expandable meshes [62, 69] can further decrease the direct costs. Most randomized data clearly demonstrate that laparoscopic repair can be performed as a day-case procedure (which was not the case for the ‘tension-free’ repair in the series of table 2).…”

“…TEP repair is recommended because of its lower complication rate [34, 62]. In cases with previous lower abdominal surgery or suspicion of bilateral hernia formation, diagnostic laparoscopy (or direct TAPP repair) should be added prior to the TEP repair [36].…”

“…Using TEP repair, bowel injuries only occur in patients with previous lower abdominal operations (appendectomy, gynecological and emergency procedures) with bowel adhesions to the scar [62]. For those patients, prior diagnostic laparoscopy or primary TAPP repair is recommended [36].…”