Laparoscopic inguinal hernia repair: audit of our experience with laparoscopic trans-abdominal pro-peritoneal repair (TAPP).

Several laparoscopic procedures have successfully passed the stage of feasibility assessment and are currently under scrutiny with regard to indications. Laparoscopic repair of inguinal hernia is a typical example of such investigations, being mostly recommended only for bilateral and recurrent hernias at the moment. We performed an audit of our experience with 100 consecutive laparoscopic trans-abdominal pro-peritoneal repairs (T.A.P.P.) on 54 patients, mostly presenting with bilateral inguinal hernias over a period of 3 years. Operative time averaged 102 minutes for unilateral repairs and 123 minutes for bilateral repairs. When other procedures were added or a recurrent hernia was treated, operative time for bilateral repairs increased to 142 and 156 minutes, respectively. Prolene mesh size was 10 x 12 cm in most patients. Hospital stay averaged 3.7 days overall, averaging 3.3 and 3 days for bilateral and unilateral repairs. Added procedures lengthened the hospital stay to 4 and 10.6 days, respectively. In 85% of patients gas was passed on postoperative day 1. Postoperative morbidity consisted in 2 major (sizable haematoma) and 20 minor complications. Pain as estimated by a VAS scale was mild to low. Follow-up was obtained in 85% of patients and revealed only 2 recurrences, 1 incisional hernia, 1 persistent swelling from a spiral tack, and 1 post-discharge bronchitis. In conclusion we believe laparoscopic inguinal hernia repair is the method of choice for treatment of bilateral and recurrent hernias and in selected cases of unilateral hernias.