A COMPARISON OF THE APPROACHES TO LAPAROSCOPIC HERNIORRHAPHY

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.