LAPAROSCOPIC TRANSPERITONEAL VERSUS EXTRAPERITONEAL INGUINAL-HERNIA REPAIR - A PROSPECTIVE CLINICAL-TRIAL

A prospective series of 106 inguinal hernias in 91 patients is studied , comparing two methods of laparoscopic hernia repair: a transperitone al technique with preperitoneal stapled mesh fixation (TransAbdominal PrePeritoneal or TAPP-technique) performed in 33 patients, and a total ly extraperitoneal placement of non stapled mesh (Totally ExtraPeriton eal Approach or TEPA-technique) performed in 58 patients. Conversions to open repair were equally frequent (5% vs. 7% respectively) and were due to adhesions, haemorrhage, irreducible intestinal loop in the her nial sac or important subcutaneous emphysema. Minor postoperative comp lications included regional seroma or haematoma, testicular pain and m eralgia paraesthetica. There was no mortality nor long lasting complic ation. Recurrence rates in both groups amounted 2.7% (TAPP) and 2.8% ( TEPA) respectively after a mean follow-up of 15.8 months (TAPP) and 17 .6 months (TEPA). In both groups early recovery of normal activities w as noted, after a mean of respectively 13.6 days (TAPP) and 12.9 days (TEPA). It is concluded that the transabdominal route and the totally extraperitoneal approach for laparoscopic herniorrhaphy are both adequ ate techniques for inguinal hernia repair with similar complication an d short-term recurrence rates.