Mini-incisional laparoscopic surgery (MILS) for inguinal hernia repair*

BACKGROUND: As meshes markedly reduce recurrence rates following surgery for inguinal hernia, surgical methods employing meshes have become increasingly popular among surgeons. Innovations in laparoscopic surgery have enabled the surgeon to minimize the size of trocar incisions. This type of laparoscopy is therefore referred to as minimal incisional laparoscopic surgery (MILS). METHODS: All inguinal hernia patients who reported at our department during the last two years were included in a prospective observational study. In order to assess the feasibility of the MILS technique as well as its benefits for the patient, we investigated and compared the following intra- and postoperative parameters of two laparoscopic TAPP (transabdominal pre-peritoneal) techniques (MILS-TAPP versus conventional-TAPP): operating times, perioperative complications, postoperative and chronic pain, abdominal wall mobility, and recurrence rates. RESULTS: Of 462 patients aged 18 to 94 years (mean, 46 years), 559 inguinal hernias in 481 patients (86.1%) were treated by laparoscopic approach. The Lichtenstein technique was used to treat 65 hernias (11.6%). The mean operating time was 60 minutes for the conventional TAPP technique (n = 217) and 56 minutes for the MILS technique (n = 264). Postoperative abdominal wall mobility scored by Janda's method was significantly superior in the MILS group (4.6) than in the conventional laparoscopic group (3.7). Postoperative pain on the VAS scale was rated 1.3 in the MILS group versus 2.6 in the conventional TAPP group. Three (1.4%) recurrences occurred after the conventional TAPP technique, whereas no hernia recurrence occurred when a self-adhesive mesh was used. CONCLUSIONS: Minimization of trauma secondary to the trocar incision was able to reduce postoperative pain and improve abdominal wall mobility. The self-adhesive mesh may be inserted by the practiced laparoscopic surgeon with no delay, and optimizes incorporation in the groin by laminar mesh adhesion in the preperitoneal cavity.