Preperitoneal prosthetic herniorrhaphy. One surgeon's successful technique

H. C. Hoffman and A. L. Traverso
Swedish Hospital Medical Center, Seattle, Wash.

OBJECTIVES: To review the senior author's experience with preperitoneal mesh inguinal herniorrhaphy, evaluate the recurrence rate, and compare it with previously published data and with the developing technique of laparoscopic herniorrhaphy. DESIGN: A retrospective records review of 204 herniorrhaphies, follow-up of patients (mean follow-up, 3.5 years), and review of the literature. SETTING: One general surgeon's clinical practice in an 860-bed regional referral hospital. PATIENTS: One hundred sixty-two men and 13 women (mean age, 63 years) who underwent preperitoneal prosthetic herniorrhaphy by the senior author between 1984 and 1991 and whose medical records were available for review (175 [96%] of 183 patients). MAIN OUTCOME MEASURES: Short- and long-term postoperative complications and hernia recurrence. RESULTS: One hundred fifty-two primary and 52 recurrent inguinal hernias were repaired using a preperitoneal prosthetic approach and either general or regional anesthesia. Wound complications occurred in 12 (5.9%) of 204 operations, and one recurrence (0.5%) was detected over the mean long-term follow-up period of 42 months (range, 7.9 to 110 months). A 25-year recurrence rate of 1% was predicted. CONCLUSIONS: This repair compares favorably with similar, previously reported repairs and is suggested as a standard for comparison with the developing technique of laparoscopic herniorrhaphy.