Laparoscopic intraperitoneal onlay inguinal herniorrhaphy

BACKGROUND: This study presents intermediate follow-up data on a randomized prospective series of patients undergoing either a modified laparoscopic i ntraperitoneal onlay mesh herniorrhaphy (IPOM) or conventional anterior ing uinal herniorrhaphy (CH). METHODS: All patients from two university affiliated hospitals with primary or recurrent inguinal hernias were recruited for randomization to either t he IPOM technique utilizing a meshed expanded polytetrafluorethylene (ePTFE ) soft tissue patch or CH. Follow-up data were gathered from postoperative clinic visits and telephone and mail surveys. RESULTS: Previously reported early recurrence and complication rates at a m ean follow-up of 8 months were 1 of 30 (3%) and 5 of 30 (17%) for IPOM, and 2 of 28 (7%) and 5 of 28 (18%) for CH. Intermediate follow-up with 50 (23 IPOM and 27 CH) of the original 58 patients (86%) at a mean of 41 months re veals a recurrence rate of 10 of 23 (43%) for the IPOM group and 4 of 27 (1 5%) for the CH group (P = 0.053). Five delayed complications occurred in 4 IPOM patients (port site hernia 4, painful neuroma 1), while 2 delayed comp lications (unilateral testicular atrophy 2) occurred in 2 patients in the C H group. One IPOM versus 5 CH patients subsequently developed previously un recognized contralateral hernias. There was 1 death unrelated to previous h erniorrhaphy in each group. CONCLUSIONS: IPOM recurrence rates (43%) at a mean follow-up of 41 months a re excessively high when compared with CH (15%) or with preliminary results of IPOM at 8 months of follow-up (3%). Despite reduced perioperative pain and disability and promising preliminary results in the IPOM group, these i ntermediate follow-up data strongly suggest that the IPOM technique should not be used for repair of inguinal hernias. Am J Surg. 1998;176:548-553. (C ) 1998 by Excerpta Medica, Inc.