PERCUTANEOUS ENDOSCOPIC EXTERNAL RING (PEER) HERNIOPLASTY

This pilot study was conducted to determine if percutaneous endoscopic external ring (PEER) hernioplasty would be a viable alternative to th e conventional and laparoscopic methods of tension-free repair. The pr ocedure consists of (1) a 2.0-2.5-cm incision over the external inguin al ring to reach the emerging spermatic cord structures, and ligation and excision of the hernia sac and (2) insertion of an endoscope-attac hed retractor through the external ring, into the inguinal canal for v isualization, dissection of posterior inguinal wall, and placement of mesh to complete tension-free repair. PEER hernioplasty was used to tr eat 48 patients with 60 primary hernias (bilateral in 12 patients) bet ween January 1993 and December 1994. Median follow-up was 12 months an d ranged from 5 to 22 months. All patients were discharged within 24 h after surgery except for one. All patients resumed their normal activ ity within 2-3 weeks. Only three complications were encountered (two s crotal hematomas and one inguinal seroma). To date, there has been rec urrence of two hernias in one patient. We conclude that PEER herniopla sty is an effective method of repair of primary hernias that is less i nvasive than the conventional approach and both less invasive and more cost-effective than laparoscopic approaches.