Laparoscopic inguinal herniorrhaphy: an individualized approach.

Between March 1991 and December 1992, we treated 63 patients with symptomatic inguinal hernias using a laparoscopic transabdominal preperitoneal approach adapted from Nyhus' technique. Treatment was individualized according to the classification of groin hernias described by Nyhus. We treated 32 type II hernia defects (indirect hernia) by preperitoneal closure of the internal ring with two to four stitches of 0-Prolene. Eighteen type IIIA (direct), three type IIIB (large indirect with weak posterior wall), and 10 type IV (recurrent) hernias were treated by fixing a prolene mesh with 0-Prolene sutures and staples from the pubic tubercle medially to the lateral aspect of the internal ring (including the cord into the mesh) laterally. The mesh was secured to the transversalis fascia and muscle and inferiorly to Cooper's ligament. No peroperative complications occurred. One patient had testicular pain of 1 week's duration after treatment of a type IV hernia. No mortality was recorded. Patients took, on an average, parenteral analgesia once (range, 0-5) and two enteral analgesics (range, 0-6). With a median follow-up of 8 months (range, 1-21), no recurrences were noted. Results are encouraging, and longer follow-up will determine the long-term efficacy of this procedure.