Laparoscopic inguinal hernia repair. A preliminary experience
D. J. Winchester, L. G. Dawes, D. D. Modelski, D. L. Nahrwold, R. A. Pomerantz, J. B. Prystowsky, R. V. Rege and R. J. Joehl
Surgical Service, Veterans Affairs Lakeside Medical Center, Chicago, Ill.
OBJECTIVE: To evaluate the safety and efficacy of laparoscopic inguinal
hernia repair. DESIGN: Nonrandomized trial. SETTING: Veterans Affairs
hospital and a large university hospital. PATIENTS: The study included 38
patients (36 male and two female) who had an acceptable risk for general
anesthesia, presented electively, and gave informed consent; patients were
excluded for whom general anesthesia had a high risk or who had
incarcerated or strangulated hernias. INTERVENTION: Laparoscopic inguinal
hernia repair was performed with general anesthesia through bilateral,
lower-abdominal, 12-mm lateral rectus sheath ports with an umbilical 30
degrees viewing laparoscope. After the peritoneum was incised and flaps
were raised, an onlay patch of polypropylene mesh, secured with staples,
covered both indirect and direct hernia regions in each patient. Small
hernia sacs were usually reduced or excised. RESULTS: From December 1991
through October 1992, 40 inguinal hernias were repaired; two patients had
bilateral hernias. There were 22 indirect and 17 direct inguinal hernias
and one femoral hernia. Nine of the hernias repaired were recurrent, and
five were sliding hernias. Complications occurred in nine patients, but
there were no recurrences during a median follow-up of 26 weeks. All but
one patient resumed preoperative activities by 7 days after the operation.
CONCLUSIONS: Laparoscopic inguinal hernia repair is an effective operation
with low morbidity. Long-term follow-up is needed to determine the
durability of the repair.
