Extraperitoneal prosthetic inguinal hernia repair using an endoscopic approach.

OBJECTIVE

To describe a laparoscopic extraperitoneal prosthetic repair technique to treat inguinal hernia defects.

SURGICAL TECHNIQUE

Operating laparoscopically in the preperitoneal plane, a piece of polypropylene mesh, placed behind the cord structures, is used to reinforce or replace the transversalis fascia. It is secured with staples placed in the fascia adjacent to Cooper's ligament and in the iliopubic tract.

PATIENTS

Our laparoscopic extraperitoneal prosthetic technique was used successfully to repair 107 direct, 142 indirect and one femoral hernia; 67% of these defects were bilateral and 30% were recurrent.

RESULTS

Operative time averaged 66 minutes and almost all patients were discharged on the day of surgery. All returned to normal activities within seven days. There were few complications and during the average follow-up period of 18 months, only one patient had a recurrent herniation that was due to a retained indirect defect. ADVANTAGES OF TECHNIQUE: The laparoscopic extraperitoneal procedure shares the same benefits attributed to traditional preperitoneal prosthetic hernia repairs: direct access to the posterior inguinal structures, clear visibility of all possible hernia defects; ability to circumvent scar tissue and intraabdominal adhesions; ease in effecting difficult repairs; avoidance of side effects associated with severance of superficial inguinal nerves; and fortification of the defect via an inlay prosthetic buttress. Moreover, the laparoscopic technique offers clear advantages to open surgery in terms of reduced pain, quicker recovery, and improved cosmesis.

CONCLUSIONS

We consider the laparoscopic extraperitoneal prosthetic repair the procedure of choice for patients with recurrent as well as bilateral inguinal defects.