Groin Hernia Repair by Laparoscopic Techniques: Current Status and Controversies

Abstract

Laparoscopic hernia repair remains controversial, and its position in current hernia surgery remains in flux. In this article we attempt to put the laparoscopic approach in perspective by describing the rationale for its development. We summarize studies comparing it with open repairs, including recent publications, meta-analyses, and systematic reviews; and we then contrast the data with recent findings of the United States Veterans Affairs Cooperative study 456. We discuss the current and future status of the laparoscopic approach to inguinal hernia repair and present an update of our own laparoscopic totally extraperitoneal technique without mesh fixation. From 1994 to 2004 we performed 314 hernia repairs on 224 patients with no intraoperative complications, no conversions to an open procedure, and no mortality. Thirty (14%) minor postoperative complications occurred. There were three herniated lipomas (preperitoneal fat) but no true peritoneal reherniations. We evaluate critical points of laparoscopic hernia repair including extensive preperitoneal dissection, mesh configuration, size and fixation, cost reduction, and the learning curve.

Comparison of the open tension-free mesh-plug, transabdominal preperitoneal (TAPP), and totally extraperitoneal (TEP) laparoscopic techniques for primary unilateral inguinal hernia repair: a prospective randomized controlled trial

“…This finding is consistent with several studies [6][7][8][9]. Although some previous studies [4,10] showed that recurrence rates were higher among patients whose hernias were repaired by the laparoscopic technique, our study did not find such evidence.…”

Long-Term Results of a Non-Ramdomized Prospective Mono-Centre Study of 1000 Laparoscopic Totally Extraperitoneal Hernia Repairs

“…The TEP approach visualizes a bilateral magnified view of the entire inguinal, femoral, and obturator space. As shown by experimental and clinical studies, meshes of 10 ϫ 15 cm are required to avoid recurrence (16,17,18,19). A large mesh tailored for each patient can be optimally positioned to cover all hernia defects with 3 minimal incisions.…”

Current opinion on laparoscopic repair of inguinal hernia

“…Summarizing the previous literature data briefly, the recurrence rate ranges from 0% to 5% for TAPP and from 0% to 2% for TEP repair [13].…”

“…The major complications rate ranges from 0% to 1.6% for laparoscopic repair and from 0% to 1.7% for open repair [13].…”