TECHNICAL CONSIDERATIONS OF THE DIFFERENT APPROACHES TO LAPAROSCOPIC HERNIORRHAPHY - AN ANALYSIS OF 500 CASES

Between April 1991 and April 1994, 500 laparoscopic herniorrhaphies ha ve been performed at our institution. The transabdominal preperitoneal approach was used for 290 repairs, and the total extraperitoneal appr oach was used for 210 repairs. Although both repairs resulted in accep table recurrence and complication rates, we adopted the total extraper itoneal approach in June 1993, with a resulting lower recurrence rate (0.5% versus 2.1%) and lower complication rate (3.1% versus 11.1%) whe n compared with the transabdominal approach. In this retrospective rev iew, four epigastric vessel injuries (1.6%) and one bowel obstruction from a port hernia (0.5%) were attributed to the lateral port placemen t in the transabdominal approach. There were also two visceral injurie s (1.0%) from entering the abdominal cavity in the transabdominal appr oach. The one visceral injury (0.6%) in the total extraperitoneal appr oach was a result of the balloon dissection in a patient with multiple previous lower abdominal operations. Better exposure and lateral visu alization of the extraperitoneal space has led to less incidence of ne rve injury (0.0% versus 2.4%) and a lower recurrence rate (0.5% versus 2.1%) in the total extraperitoneal approach. The total extraperitonea l approach to laparoscopic herniorrhaphy compares favorably to the tra nsabdominal approach in our institution. The improved results may have been due to the technical differences between these approaches.