THE EFFECT OF PREVIOUS LOWER ABDOMINAL-SURGERY ON PERFORMING THE TOTAL EXTRAPERITONEAL APPROACH TO LAPAROSCOPIC HERNIORRHAPHY

At Georgia Baptist Medical Center in Atlanta, GA, we adopted the total extraperitoneal approach (TEPA) to laparoscopic herniorrhaphies becau se of the concerns of potential early and late complications associate d with entering the abdominal cavity, In our institution, the TEPA has compared favorably with the transabdominal approach, with lower compl ication and recurrence rates. There has been concern, however, in perf orming the TEPA in patients with previous lower abdominal surgery. The question has been raised that there is increased risk of complication s in these patients, From June 1993 to May 1994, we performed 247 lapa roscopic herniorrhaphies in 192 patients using the TEPA. Of these, 55 hernias were repaired in 45 patients with previous lower abdominal sur gery. Overall retrospective results showed a slightly higher complicat ion rate (23.1% vs 11.3%) and slightly higher recurrence rate (1.8% vs 0%) in the patients with previous surgery over those without, Althoug h these differences are not statistically significant, it is important to keep these risks in mind when selecting the appropriate hernia rep air for each patient.