Minimally invasive approaches to inguinal hernia repair.

Since their first description in 1992, laparoscopic inguinal hernia repair procedures have been steadily increasing in number. With the standardized teaching of both transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) approaches, laparoscopic repair is now a safe and widespread procedure. The use of different types of prosthetic mesh in inguinal hernia repair has aided the resolution of larger hernias; however, the literature is vast concerning mesh comparisons. We present a systematic review of the current literature on the laparoscopic inguinal hernia technique and prosthetic mesh use. Neither TEP nor TAPP has shown a distinct advantage--both procedures are acceptable. Lightweight mesh is a promising option and biologic mesh is a novel approach; however, both types are lacking randomized, controlled studies. Fixation of prosthetic has been shown by randomized, controlled trials to be unfavorable in most hernia repairs. The addition of prostheses to laparoscopic repair has greatly aided in the treatment of inguinal hernia. However, more prospective, randomized, controlled trials focused on the efficacies of lightweight and biologic meshes and directed toward developing specific guidelines for nonfixation versus fixation need to come to fruition before an operating standard can be set.