Laparoscopy identifies unexpected groin hernias

Abstract

Diagnostic laparoscopy performed before laparoscopic repair of groin hernias offers an opportunity to examine all hernial orifices. This study was undertaken to evaluate the accuracy of the preoperative clinical diagnoses and to determine the frequency of unexpected groin hernias. Between December 1990 and November 1997, 253 patients (243 male) underwent laparoscopic repair of 560 hernias. The total extraperitoneal technique was used in 93 per cent of the cases. Diagnostic laparoscopy was performed before and after the preperitoneal dissection and repair. Preoperatively, hernias were thought to be unilateral in 73 patients (Group A) and bilateral in 180 patients (Group B). Incorrect diagnoses in 50 of 73 patients (68%) thought to have unilateral hernias included bilateral hernias in 37 patients (50%), a different type of ipsilateral inguinal hernia in 7 patients (10%), or a femoral hernia in 6 patients (8%). Incorrect diagnoses in 91 of 180 patients (50%) thought to have bilateral hernias included a different and/or additional type of ipsilateral inguinal hernia on either side in 63 patients (35%), a femoral hernia in 21 patients (12%), or a unilateral hernia in 7 patients (4%). Unexpected hernias that would not have been treated with an anterior approach were found in 64 patients (25%; 27 were femoral and 37 were contralateral). The laparoscopic technique allows for identification and repair of previously undiagnosed contralateral and femoral hernias at the first operation.