Laparoscopic hernia repair: a rural perspective.

Laparoscopic hernia repair has been used successfully to repair inguinal as well as some ventral, incisional, and umbilical hernias. The laparoscopic approach is favored by patients because they experience little, if any, postoperative pain and enjoy a rapid return to unrestricted activity. We repaired 84 hernias in 61 patients from March 1991 to December 1992. All patients were treated by the author in rural west-central Minnesota hospitals, each of which has 30 beds or less. A unique preperitoneal patch design was used, and a novel technique for the dissection of an indirect hernia sac was developed. The patient population treated was older than that reported in other series, with an average age of 55 and a median age of 61 years. Based on postoperative interviews, 95% of the patients reported being satisfied with the procedure and their outcome. All ten patients who had also experienced traditional hernia surgery preferred the laparoscopic repair. They cited less postoperative pain and a quicker return to full activity as the main reasons for their preference. Of the three patients who had a recurrence of their hernia, two have had a repeat laparoscopic hernioplasty without subsequent recurrence. The third patient has indicated that he plans to have his recurrent hernia repaired laparoscopically again. One hundred percent of the patients indicated that they would choose to have a laparoscopic hernia repair should they need another hernia repaired in the future.