Intraoperative and postoperative complications of totally extraperitoneal laparascopic inguinal hernioplasty

Inguinal hernioplasty using extraperitoneal laparoscopy is a new surgical o ption but still controversial because of the great technical difficulty inv olved. To analyze the clinical factors that could be related to intraoperat ive and postoperative morbidity, a prospective study was performed of 131 p atients (153 repairs) undergoing totally extraperitoneal endoscopic surgery for inguinal hernia in an Outpatient Surgery Unit. Clinical parameters (ag e, sex, associated diseases, prior abdominal surgery, site and type), intra operative complications (detachment of epigastric vessels, preperitoneal bl eeding, rupture of the peritoneal sac, subcutaneous emphysema, problems wit h extending the mesh, visceral or deferential lesions, and rate: of reconve rsion), postoperative complications (haematomas, urinary retention, transit ory pain, neuralgias, and infections), and rate of recurrence were evaluate d. Follow-up averaged 18 months (range, 1-3 years) and was complete in 100% of the patients. Intraoperative morbidity was 47%; postoperative, 16%; and the rate of reconversion, 4%. The rate of readmissions was 0%. One patient underwent reoperation for suspected early recurrence. The following statis tically significant relations were shown: bleeding to recurrent hernias; pr esence of pain to hematomas; peritoneal rupture to female sex, diabetes, pr ior infraumbilical surgery and bilateral site; detachment of epigastric ves sels Co absence of prior surgery and hernia type 3a; and hematomas to age o lder than 50 years (P < 0.05). The preperitoneal laparoscopic technique is a difficult surgical operation, which often requires added interventions to resolve unexpected problems. The complications are acceptable, and the rat e of recurrence is low (0.65%). We establish a standard for selecting patie nts during a program of apprenticeship.