title: Laparoscopic hernioplasty: why does it work?
abstract: BACKGROUND
  To understand how laparoscopic hernioplasty prevents early recurrence of hernia, we reviewed our first 1,000 patients. We analyzed the patients by age, sex, and hernia type and by whether their hernia was primary or recurrent.
  
  
  METHODS
  The 1,000 patients had 1,336 hernias repaired by the transabdominal preperitoneal or the totally extraperitoneal approach. One thousand one hundred seventy-three hernias were primary and 163 were recurrent. The type of hernia found varied with the patient's age (p < 0.001), and with whether the hernia was primary or recurrent (p < 0.001); 14% of primary and 27% of recurrent hernias were complex, a surprisingly high incidence compared to historical controls.
  
  
  RESULTS
  With a median follow-up of 2 years, five hernias have recurred and all were due to technical errors.
  
  
  CONCLUSIONS
  The laparoscopic repair's success may partially be due to its unique ability to diagnose previously overlooked complex elements. The defects are repaired without creating tension and the groin is reinforced with mesh, eliminating inherent weakness.
authors.affiliation: Center for Hernia Repair, Fresno, CA 93710, USA.
authors.forename: E L
authors.initials: EL
authors.lastname: Felix
authors.forename: C A
authors.initials: CA
authors.lastname: Michas
authors.forename: M H
authors.initials: MH
authors.lastname: Gonzalez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D015994:Incidence; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology*; D011379:Prognosis; D012008:Recurrence; D013526:Surgical Mesh