Background: There are a variety of accepted techniques for herniorrhap
hy. With the advent of laparoscopic general surgery, new endoscopic te
chniques using the transabdominal and total extraperitoneal approaches
have been added to the many options for the repair of inguinal hernia
. The purpose of this study was to compare the early results of these
approaches at a single institution. Methods: Between May 1991 and Augu
st 1994, 600 laparoscopic herniorrhaphies were pet-formed on 493 patie
nts. Three hundred hernias were repaired using the transabdominal prep
eritoneal approach and 300 were repaired using the total extraperitone
al approach. A retrospective review was performed with emphasis on the
comparison of recurrence rates and complication rates between these t
wo approaches to laparoscopic herniorrhaphy. Results: The recurrence r
ates were 2.0% (6/300) for the transabdominal approach and 0.3% (1/300
) for the total extraperitoneal approach. The complication rate for th
e transabdominal approach was 10.7% and included thigh paresthesias (6
), inferior epigastric artery injuries (4), enterotomy (I), bowel obst
ruction (1), bladder injury (I), and urinary retention (14). The compl
ication rate for the total extraperitoneal approach was 3.7% and inclu
ded enterotomies (2), bladder injury (1), paresthesia (1), and urinary
retention (6). The recurrence, the enterotomies, and the bladder inju
ry in the total extraperitoneal group were air in patients who had pre
vious lower abdominal operations. Conclusions: Although both the trans
abdominal preperitoneal and total extraperitoneal approaches to laparo
scopic herniorrhaphy have acceptable recurrence and complication rates
, there were significant advantages to the total extraperitoneal appro
ach in our institution. Previous lower abdominal surgery may be a rela
tive contraindication to the total extraperitoneal approach.