THE INCIDENCE OF SECONDARY HERNIAS DIAGNOSED DURING LAPAROSCOPIC TOTAL EXTRAPERITONEAL INGUINAL HERNIORRHAPHY

During a 24-month period beginning in July of 1995, laparoscopic total extraperitoneal inguinal herniorrhaphy was attempted in 53 patients. All procedures were performed at a single institution, by senior-level general surgery residents, With the same attending surgeon functionin g as first assistant. Three patients required conversion to an ''open' ' procedure (all had a prior history of herniorrhaphy or lower abdomin al surgery), leaving 50 patients for analysis. Preoperatively, a unila teral hernia was evident on clinical grounds in 29 patients, the remai ning 21 presenting with signs of a bilateral hernia; of the total, 11 had a history of prior hernia repair on the presently affected side. A t surgery, a total of 115 hernia defects (indirect, direct, femoral) m ere identified, 38% of which were discovered only at the time of surge ry. Sixty-four percent of patients were found to have at least one of these ''secondary'' hernias. After reduction of the hernia(s), all def ects mere covered with polypropylene mesh secured with spiral tacks. T here were 10 perioperative complications, one of which required correc tive surgical intervention. Over 70% of patients were discharged on th e day of surgery; 92% returned home within 23 h of their operation. Th e most common reason for delay of hospital discharge was urinary reten tion. There have been no recurrences in short-term follow-up. Most pat ients were pleased with the recovery time from and the cosmetic result s of their surgery. These results suggest that laparoscopic total extr aperitoneal herniorrhaphy represents a safe, effective, cosmetically a ppealing alternative to open hernia repair. Moreover, this approach ma y provide an added advantage insofar as identifying additional hernia defects that, when repaired, mag ultimately yield a lower recurrence r ate than might otherwise have been expected.