EXTRAPERITONEAL PROSTHETIC INGUINAL-HERNIA REPAIR USING AN ENDOSCOPICAPPROACH

Objective. To describe a laparoscopic extraperitoneal prosthetic repai r technique to treat inguinal hernia defects. Surgical Technique. Oper ating laparoscopically in the preperitoneal plane, a piece of polyprop ylene mesh, placed behind the cord structures, is used to reinforce or replace the transversalis fascia. It is secured with staples placed i n the fascia adjacent to Cooper's ligament and in the iliopubic tract. Patients. Our laparoscopic extraperitoneal prosthetic technique was u sed successfully to repair 107 direct, 142 indirect and one femoral he rnia; 67% of these defects were bilateral and 30% were recurrent. Resu lts. Operative time averaged 66 minutes and almost all patients were d ischarged on the day of surgery. All returned to normal activities wit hin seven days. There were few complications and during the average fo llow-up period of 18 months, only one patient had a recurrent herniati on that was due to a retained indirect defect. Advantages of Technique . The laparoscopic extraperitoneal procedure shares the same benefits attributed to traditional preperitoneal prosthetic hernia repairs: dir ect access to the posterior inguinal structures, clear visibility of a ll possible hernia defects; ability to circumvent scar tissue and intr aabdominal adhesions; ease in effecting difficult repairs; avoidance o f side effects associated with severance of superficial inguinal nerve s; and fortification of the defect via an inlay prosthetic buttress. M oreover, the laparoscopic technique offers clear advantages to open su rgery in terms of reduced pain, quicker recovery, and improved cosmesi s. Conclusions. We consider the laparoscopic extraperitoneal prostheti c repair the procedure of choice for patients with recurrent as well a s bilateral inguinal defects.