Sutureless laparoscopic extraperitoneal inguinal herniorrhaphy using reusable instruments; Two hundred three repairs without recurrence

Laparoscopic extraperitoneal hernia repair has several distinct advantages over the anterior repair and the laparoscopic transabdominal preperitoneal method. Laparoscopic extraperitoneal hernia repair allows detection and rep air of occult contralateral defects with minimal risk of intraabdominal inj ury or adhesion formation and is associated with less pain and a quicker re covery. However, there are disadvantages. Circumferential mobilization of t he spermatic cord and the use of staples to secure the mesh have been assoc iated with injury to the spermatic cord and nerves. The cost of the laparos copic approach is higher than that of open hemiorrhaphy. Additionally, it i s more difficult to do because there is a poor understanding of the preperi toneal fascial anatomy. A method of totally extraperitoneal inguinal hernio rrhaphy emphasizing anatomic dissection and landmarks is described. The aut hors use only reusable instruments, no balloon dissector, and no fixation o f the mesh. The wide dissection of the myopectineal orifice allows placemen t of a large mesh and utilizes intraabdominal pressure alone to secure the mesh on the posterior aspect of the abdominal wall, as described by Stoppa et al. (I). Operative costs are minimized. From experience with 203 suturel ess extraperitoneal repairs, a low incidence of complications and no recurr ences are demonstrated. It is extrapolated that the cost of this laparoscop ic repair will approximate more closely that of open anterior herniorrhaphy .