Laparoscopic inguinal herniorrhaphy.

Abstract

Currently accepted laparoscopic inguinal herniorrhaphies are of three types: Trans-Abdominal Pre-Peritoneal (TAPP), Intra-Peritoneal Onlay Mesh (IPOM), and Totally Extra-peritoneal (EXTRA). The TAPP procedure is the most commonly performed operation. The peritoneum is opened transversely above the hernia defect and a radical dissection of the pre-peritoneal space accomplished. The hernia defect is widely covered with a large prosthesis, and the mesh is secured with staples. The peritoneum is then closed over the prosthesis. The IPOM technique has become the second most common laparoscopic inguinal herniorrhaphy. A prosthesis is placed on the intra-abdominal side of the peritoneum and stapled in place using the same landmarks as for the TAPP. This avoids an extensive dissection of the pre-peritoneal space. However, it must be considered as an experimental procedure because of the possibility of complications caused by adhesions to the intra-abdominally placed prosthesis. The third type of laparoscopic inguinal herniorrhaphy is the EXTRA. The hernia is repaired using laparoscopic instrumentation without violating the peritoneum by dissecting the space between the peritoneum and the transversalis fascia, beginning at the umbilicus. Once the inguinal region is entered, the procedure is similar to the TAPP. However, it is more difficult than the TAPP because of the small working space, especially for the inexperienced. Early results suggest that laparoscopic inguinal herniorrhaphy is an effective method for correcting an inguinal hernia. It can be performed with a reasonably low morbidity. Indications remain to be determined. A randomized prospective study comparing laparoscopic inguinal herniorrhaphy with conventional is warranted.