Endoscopic extraperitoneal herniorrhaphy. A 5-year experience.
BACKGROUND
This report reviews our experience with 512 groin hernias treated by a laparoscopic extraperitoneal approach over the past 5 years. We detail the modifications that have been made to this procedure and compare our morbidity and recurrence rates with other laparoscopic and open herniorrhaphy techniques.


METHODS
Between September 1991 and September 1996, 395 male patients underwent 512 hernia repairs by an endoscopic total extraperitoneal approach (TEP). Their ages ranged from 18 to 82 years. There were 267 indirect, 218 direct, 17 pantaloon, and 10 femoral hernias. Of these, 117 were bilateral and 54 were recurrent. All repairs were done with polypropylene mesh. All patients were given general anesthesia except 16 (4.05%) who had epidural anesthesia.


RESULTS
Of 512 hernia repairs, seven required conversion to an open procedure (1.3%). There were 19 complications (4.8%), including eight cases of urinary retention, six of groin collection, one bladder injury, one trocar site infection, one transient neuralgia, one cardiac arrhythmia, and one laryngospasm. Follow-up on 354 patients (41 were lost to follow-up) ranged from 6 to 66 months (mean, 38). There were six hernia recurrences (1.69%), but no deaths. Operative time ranged from 15 to 185 min.


CONCLUSIONS
The endoscopic extraperitoneal approach to groin hernia repair has a recurrence rate comparable with open and other laparoscopic techniques. Operative time has decreased considerably with experience. Familiarity with the technique has eliminated the need for balloon dissectors, cauteries, suction irrigation, Foley catheters, and stapling of the mesh. These advances, along with shortening of the operative time and employment of reusable trocars, have permitted a significant decrease in the cost of the procedure. This study provides the longest follow-up reported with this technique. In experienced hands, the TEP repair produces results that are comparable with the open, tension-free repair and represents a reasonable alternative.
Ferzli
G
G
Department of Laparoscopic Surgery, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA.
Sayad
P
P
Huie
F
F
Hallak
A
A
Usal
H
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004724:Endoscopy; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome