Laparoscopic repair of inguinal hernia

Abstract

Objective: To present the outcome of 123 groin hernias treated laparoscopically between July 1991 and October 1993, and to discuss the advantages of preperitoneal hernia repair with mesh.

Design: Data for each patient were collected prospectively on a predetermined standard form. Every patient was assessed by an independent, non-treating surgeon.

Patients and setting: Ninety-seven patients underwent laparoscopic hernia repair by two surgeons between July 1991 and October 1993. The patients were treated in several private hospitals and one public hospital in Sydney, NSW.

Main outcome measures: Each patient was assessed for integrity of the hernia repair, the number of days before return to work, analgesic requirement after surgery, and complications.

Results: There were five hernia recurrences, and repairs in three other patients were considered doubtful by the non-treating surgeon assessor; these repairs were later judged to be sound. There were no infections and no serious complications. There was one scrotal haematoma, one incisional hernia through a trocar site, one hydrocoele and one trocar injury to a large branch of the inferior epigastric artery. Sixty-two per cent of patients required no analgesic injections. Patients covered by workers' compensation returned to work an average of 24 days after their operations and employed patients not covered returned to work an average of 12 days after their operations. Twenty-one patients had been treated previously by open inguinal herniorrhaphy and all enthusiastically endorsed the laparoscopic repair because of reduced pain and earlier return to physical activity. One patient was found to have omental adhesions to the site of the hernia repair at a subsequent laparoscopy.

Conclusions: Laparoscopic inguinal herniorrhaphy has the advantages of reduced pain and rapid return to normal activity when compared with open techniques. The mesh prosthesis placed in the preperitoneal space behind the weakened inguinal region appears to confer strength and eliminates the disadvantage of tension observed with sutured repairs.