Laparoscopic repair of bilateral and recurrent hernias

The optimal inguinal hernia repair has been controversial for decades. Sinc e the advent of minimally invasive surgery, laparoscopic techniques have ad ded to the controversy. Laparoscopic hernia repair has been advocated by ma ny experts for the repair of bilateral and recurrent inguinal hernias. This study reviews the experience of a single community-based teaching hospital using the total extraperitoneal (TEP)-approach laparoscopic hernia repair for treating patients with bilateral and/or recurrent inguinal hernias. Sin ce the TEP approach was adopted in June 1993, a total of 457 patients were treated for bilateral (322 patients) and/or recurrent (175) inguinal hernia s (40 patients had recurrent and bilateral hernias). A total of 779 hernias were repaired with this technique. The average age of this patient group w as 47 years, and there were 413 males and 44 females. Operative time averag ed 68.3 minutes per patient, and there were 26 (5.7%) minor complications. There were 2 (0.4%) major complications, an enterotomy and a cystotomy, bot h early in the series and both in patients with previous lower abdominal su rgery. There have been no deaths. With an average follow-up of 30 months (r ange, 1-60 months), there have been three (0.2%) recurrences. These recurre nces were due to technical problems (inadequate mesh coverage), and each wa s repaired with a laparoscopic transabdominal approach or an anterior open approach. The use of the TEP-approach laparoscopic hernia repair is safe an d effective in patients with recurrent and/or bilateral inguinal hernias.