ASSESSING RISKS, COSTS, AND BENEFITS OF LAPAROSCOPIC HERNIA REPAIR

Laparoscopic inguinal herniorrhaphy (LIHR) was introduced with the fol lowing potential advantages: less postoperative discomfort and pain, r educed recovery time that allows earlier return to full activity, easi er repair of a recurrent hernia, the ability to treat bilateral hernia s concurrently, the performance of a simultaneous diagnostic laparosco py, ligation of the hernia sac at the highest possible site, improved cosmesis, and decreased incidence of recurrence. Potential disadvantag es include complications, such as bowel, bladder, and vascular injurie s; potential adhesive complications at sites where the peritoneum has been breached or prosthetic material has been placed; the apparent nee d, at least at the present, for a general anesthetic; and the increase d cost because of expensive equipment needs. Most surgeons agree that LIHR has a role in the management of patients with a recurrent hernia after a conventional inguinal herniorrhaphy (CIHR), bilateral inguinal hernia, or a need for laparoscopy for another procedure, such as lapa roscopic cholecystectomy. The routine use of LIHR for the unilateral, uncomplicated hernia is a more contentious issue.