SPAWS LAPAROSCOPIC INGUINAL-HERNIA REPAIR USING AN EPTFE INTRAPERITONEAL PATCH - PRELIMINARY-RESULTS OF A PROSPECTIVE-STUDY OF 162 HERNIORRHAPHIES IN 135 PATIENTS

Spaw's (original and modified) was technique evaluated in a prospectiv e, multicentre study : from november 1992 to september 1993, 162 intra peritoneal laparoscopic herniorraphies were carried out in 135 patient s for recurrent hernias or for hernias associated with a high risk of recurrence. Three needed an open procedure. Three early complications (2 peri prosthetic hematomas, 1 microscopic bladder injury) were treat ed by another laparoscopy ; a bowel loop retained in a trocar orifice was reintegrated under local anesthesia ; dysesthesias of the lateral cutaneous nerve of the thigh in 1 patient and nonspecific parietal pai n in 2 patients resolved within three weeks. Three seromas resolved af ter only one percutaneous aspiration. The mean post operative pain, ev aluated by a visual analogic scale graduated from 1 to 10 was 1,8 (0 t o 6) at D1, 0.5 (0 to 2) at D2 and the mean duration of analgesic requ irments was 1.7 (0 to 15) days. The mean hospital stay was 2 (1 to 17) days for unilateral herniorraphies and the mean time to return to wor k or normal activity was 10 (2 to 44) days, even in heavy workers (35 patients). All patients were reviewed. The mean follow-up was 4 (1 to 10) months. Two complications needed further laparoscopic treatment : 1 recurrence at the internal edge of the patch, easily restapled with a stronger stapler, 1 bowel adhesion between patch and bladder reveale d by pain without obstruction. The recurrence rate was 0.6 % (1/162). The conversion rate was 2 % (3/162) and the overall morbidity was 7.5 % (12/162), decreasing respectively to 0 and 4 % after the learning cu rve. This study confirms that Spaw's technique and its variant are fea sible, and allows us to continue this study, and suggest these techniq ues would be useful in the treatment of some recurrent inguinal hernia s.