Endoscopic extraperitoneal inguinal hernia repair: a series of 182 repairs.

INTRODUCTION: The local experience of endoscopic totally-extraperitoneal hernia repair in a major teaching hospital is reviewed.
METHODS: Between 1997 and 2003, 141 consecutive patients underwent 182 totally-extraperitoneal hernia repairs for inguinal hernia. 100 patients had unilateral hernia and 41 patients had bilateral hernias. The mean age was 51 years (range 20 to 83 years).
RESULTS: The mean operation duration was 70 minutes. Bilateral repairs took 24 percent longer than for unilateral repairs (82 versus 66 minutes). However, the mean operative duration for the last 55 (30 percent) cases decreased to 55 minutes. Four patients (2.8 percent) had conversion to open surgery and ten patients had minor complications, mostly groin seroma that resolved. Overall, there were seven hernia recurrences (3.8 percent) in the series. However, no hernia recurrence was present in the last 63 patients (45 percent). Recurrences were higher when the mesh was not anchored than when the mesh was fixed with a tacking device (p value is less than 0.01). The mean inpatient hospital stay was 1.4 days. Of the last 30 patients (21 percent), 70 percent were performed as outpatients.
CONCLUSION: Endoscopic extraperitoneal hernia repair offers the appropriate patient a viable alternative to open hernia surgery. To achieve good results, adequate cases should be performed to overcome the learning curve, and the mesh should be anchored to the inguinal floor to prevent recurrences.