Transperitoneal or totally extraperitoneal approach in laparoscopic hernia repair: results of 491 consecutive herniorrhaphies.

Laparoscopic hernia surgery was introduced in this unit in May 1992. Up to November 1995, 426 patients with 491 inguinal and femoral hernias have undergone surgery. A transabdominal preperitoneal (TAPP) approach was used in 339 patients with 393 hernias. After June 1994 a totally extraperitoneal (TEP) technique was used in 87 patients with 98 hernias. This prospective nonrandomized study deals with the learning curve, complications, and early results. The mean (SD) follow-up times in the TAPP and TEP groups were 23 (9) and 7 (4) months, respectively. Mean operating times and hospital stays did not differ between the TAPP and TEP patients, but the period off work was shorter in the TEP group. Fifteen major complications, including one postoperative death, two bowel obstructions, one severe neuralgia, three trocar hernias, one epigastric artery bleeding episode, and seven recurrences, were recorded; all except one was in the TAPP group. The TEP operation may be the method of choice in laparoscopic hernia surgery.