ENDOSCOPICALLY GUIDED PERCUTANEOUS REPAIR OF INGUINAL-HERNIA THROUGH A 2-CM INCISION - MINIHERNIA REPAIR

Background: The laparoscopic repair of inguinal hernia is still contro versial. Transabdominal preperitoneal repair violates the peritoneal c avity and may result in visceral injuries or intestinal obstruction. T he laparoscopic extraperitoneal approach has the disadvantage of being technically demanding and requires extensive extraperitoneal mobiliza tion. The Lichtenstein repair gives good long-term results, is easy to learn, can be performed under local anesthesia. but requires a larger incision. Methods: We describe a novel percutaneous tension-free pros thetic mesh repair performed through a 2-cm groin incision. The inguin al canal is traversed with the aid of a 5-mm video-endoscope and the c anal is widened using specially designed balloons. Spermatic cord mobi lization, identification and excision of the indirect sac, and posteri or wall repair are carried out under endoscopic guidance. Results: Bet ween October 1993 and July 1995, 85 primary inguinal hernia repairs (4 5 indirect and 33 direct) were performed on 81 patients (80 men, one w oman) by the author (A.D.). The mean age was 41 years (range 17-83 yea rs). Six repairs were performed under local anesthetic. Mean operative time was 42 min (range 25-74). Mean hospital stay was 1.2 days (0-3 d ays). The mean return to normal activity was 8 days (2-10 days). Eight complications have occurred: a serous wound discharge, two scrotal he matomas, a scrotal swelling that resolved spontaneously, wound pain la sting 2 weeks, an episode of urinary retention, and two recurrences ea rly in the series (follow-up 1-22 months). Conclusion: The endoscopica lly guided percutaneous hernia repair avoids the disadvantages of lapa roscopy (i.e., lack of stereoscopic vision, reduced tactile feedback, unfamiliar anatomical approach, risk of visceral injury), yet the use of endoscopic instrumentation allows operation through a 2-cm incision . The minihernia repair thus combines the virtues of an open tension-f ree repair with minimal access trauma.