Laparoscopic inguinal hernia repair: New policies

This paper describes our most recent experience with laparoscopic inguinal hernia repair. From September 1993, our aim was to perform a more 'tailor-made' treatment depending on the local findings during laparoscopic inspection of the inguinal region. Inspection was performed by a strictly preperitoneal approach in the majority of patients and by a transperitoneal approach in patients who had had previous surgery in the retro-inguinal or prevesical space. Twenty patients had the transperitoneal approach, and 360 had the preperitoneal approach. Repair of the hernia consisted of a simple reduction of the sac without parietal reinforcement in 9 patients with a Nyhus I hernia, and in reduction of the sac plus suture narrowing of the internal inguinal ring in 1 patient with bilateral Nyhus II hernias. 370 patients were staged as Nyhus III or IV and underwent mesh placement after hernia reduction. There was one major postoperative complication in a patient treated with mesh who presented a hematoma requiring drainage after 6 weeks. Five recurrences were noted with a follow-up time of 18 months. They all occurred in patients treated preperitoneally without mesh fixation for Nyhus III or IV. The tailor-made laparoscopic approach to inguinal hernia repair performed preperitoneally, or transperitoneally in selected cases, is safe and reliable as far as can be evaluated with this short follow-up.