Laparoscopic hernia repair. Three-year experience.

The basis of laparoscopic transabdominal preperitoneal repair (LTPR) of herniae rests upon the utilization of a prosthetic screen to cover hernia defects. Preperitoneal prosthetic screen interposition reproduces the effect of the inguinal shutter mechanism. In this 3-year longitudinal study, one surgeon performed 224 laparoscopic hernia repairs (LTPR) on 164 patients. These patients have been examined postoperatively by that surgeon and a trained research assistant according to an established protocol. Patient mean age was 50.6 years; 45 cases involved bilateral inguinal herniae (21.5%); 20 laparoscopic repairs were for failed open repair (9.6%); and 46 herniae were incarcerated (22%) at the time of laparoscopic repairs. There were no intraoperative complications. Two procedures required conversion to open repair, the first because of uncertainty regarding incarcerated bowel viability and the second for massive abdominal-wall adhesions. Two laparoscopic repairs recurred and required subsequent repair.