Ja. Windsor et H. Mccay, INGUINAL-HERNIA REPAIR BY LAPAROSCOPIC SURGEONS - EARLY EXPERIENCE AND ATTITUDES, Australian and New Zealand journal of surgery, 65(7), 1995, pp. 470-474
The introduction of laparoscopic inguinal hernia repair (LIHR) has bee
n controversial. A questionnaire was sent to all general surgeons in N
ew Zealand to document the early experience with LIHR and attitudes to
wards it. Of the 118 replies (response rate 55%), 74 were from laparos
copic surgeons, 26 of whom bad performed 564 (201 public, 363 private)
LIHR (23 bilateral) until January 1994. Only nine (35%) of these surg
eons had assisted an experienced surgeon before performing an LIHR, an
d only four (158) were supervised by an experienced surgeon during the
ir first case. The transabdominal preperitoneal technique of LIHR was
used by 14 (54%) surgeons, the extraperitoneal technique by eight (31%
), and the transabdominal onlay technique by four (15%). There were 29
(5%) recurrences, 17 (3%) neuropathies, seven (1.2%) conversions, fou
r (0.7%) major perforations, and one (0.17%) death. Of the 26 surgeons
who performed LIHR, 20 (77%) were concerned about the absence of long
-term results, 14 (54%) considered that the optimal technique had not
been established, 13 (50%) were concerned about the unique complicatio
ns associated with LIHR, 11 (42%) were less enthusiastic about perform
ing LIHR than previously, 10 (38%) were doubtful about its advantages,
and six (23%) were uncertain about its future and considered that it
should only be performed within the concert of a controlled trial. Thi
s study highlights a number of issues that need to be addressed before
the role of LIHR can be determined.