Laparoscopic inguinal hernia repair is still at an investigational sta
ge, and varying methods have been described in the literature. These i
nclude the transabdominal preperitoneal approach, the intraperitoneal
onlay mesh procedure, and the extraperitoneal approach. This, study ev
aluates the differences in macroscopic adhesion formation between tran
sabdominal preperitoneal mesh placement, intraperitoneal onlay mesh pr
ocedures, and extraperitoneal mesh placement in a canine model. The de
termination of microscopic tissue ingrowth and mesh incorporation was
not a goal of this study. Operative sites utilizing mesh in a reperito
nealized fashion resulted in less adhesion formation than did those si
tes where mesh was placed in an intraperitoneal manner using the onlay
technique. Mesh placed in the extraperitoneal space without entering
the peritoneal cavity did not exhibit any adhesion formation. Results
favor the reperitonealization of intraabdominal mesh or mesh placement
by an extraperitoneal approach.