LAPAROSCOPIC HERNIA REPAIR - A PRELIMINARY-REPORT

Advances in laparoscopic technique have provided the opportunity to pe rform preperitoneal herniorrhaphy and potentially avoid the morbidity associated with open techniques. From January 1991 to May 1992, two pr imary surgeons repaired 63 inguinal hernias (42 indirect, 20 direct, 1 femoral) on 48 patients using a standardized laparoscopic technique. The hernia defect was visualized laparoscopically, and the peritoneum anterior to the defect was incised. The hernia sac was dissected from the inguinal canal. The hernia defect was then loosely packed with rol led 1 x 6-inch polypropylene mesh (average number of rolls used was 3. 4). A sheet of polypropylene mesh (average 5 x 8 cm) was then placed o ver the mesh rolls and the hernia defect and anchored with an endostap ler. The peritoneum was closed over the mesh sheet with standard lapar oscopic clips. There were 44 males and 4 females in the study group. T he mean age was 55 years (range, 17-89 years). The mean follow-up was 5.8 months (range, 1-12 months). Thirty-three patients underwent unila teral hernia repair, and 15 patients underwent bilateral hernia repair . Clinically unsuspected contralateral hernias were identified at the time Of laparoscopy in seven patients. The mean duration of surgery wa s 118 minutes (range, 80-165 minutes) for bilateral hernia repair, and 70 minutes (range, 45-100 minutes) for unilateral hernia repair. All patients with laparoscopic hernia repairs were treated on a same-day o r less-than-24-hour in-hospital stay. Complications were designated as minor, moderate, or severe. There were 14 minor complications, which included subcutaneous hematomas at the trocar site, scrotal ecchymosis , groin swelling emphysema, and testicular asymmetry. All were resolve d by the 3-week follow-up. Moderate complications included two patient s requiring open exploration for removal of polypropylene rolls second ary to persistent pain and two patients with pain greater than 3 weeks duration. There were two severe complications including one hemorrhag e with postoperative EKG changes and one small bowel obstruction occur ring at a trocar site. Ninety per cent of the patients returned to ful l activity within 1 week postoperatively. Follow-up to date shows no e vidence of hernia recurrence. Patient satisfaction appears more favora ble with laparoscopic surgery than with conventional herniorrhaphy.