Laparoscopic inguinal hernia repair: over a thousand convincing reasons to go on.
BACKGROUND
Laparoscopic hernia repair has emerged as an effective alternative method for treating inguinal hernias. The ability to provide this service as day surgery or short-stay (23-h stay) treatment makes it an attractive method in this age of resource limitations. The technique is cost-effective when the use of disposable instruments is kept to a minimum.


METHODS
Our team performed laparoscopic transabdominal pre-peritoneal (TAPP) inguinal hernia repair on 1,389 patients in the period from September 1999 to March 2007. We take this opportunity to discuss the lessons we have learnt and our experience and views with regards to certain procedure-specific problems encountered by many of our peers.


RESULTS
A variety of commonly encountered inguinal and groin hernias were treated by TAPP with good results, minimal morbidity (4.39%) and one mortality. We have discussed our views on technical aspects of the procedure, such as the extent of pre-peritoneal dissection, methods of treating the hernia sac, the size and number of pre-peritoneal prosthetic meshes deployed, fixation of the mesh and reconstitution of the peritoneum. Our views on the causes and our strategies for managing complications such as seroma formation (3.09%), recurrence (0.29%), bleeding (0.36%) and mesh infection (0.14%) have been outlined. We believe that incidental hernias (N=150) discovered during initial laparoscopy can be safely treated with no added morbidity, provided the patients' views and consent regarding the treatment are given due consideration.


CONCLUSIONS
Laparoscopic TAPP hernia repair has proven to be an efficient method of providing treatment for groin hernias. Our experience over the last eight years has given us over a thousand convincing reasons to continue working and improving upon this service.
Balakrishnan
S
S
Department of Surgery, Surgical Admin 4, North Wing, Level 2, The Princess Royal University Hospital, Farnborough Common, Orpington, Kent, BR6 8ND, UK. santosurg@yahoo.com
Singhal
T
T
Samdani
T
T
Hussain
A
A
Shuaib
S
S
Grandy-Smith
S
S
Nicholls
J
J
El-Hasani
S
S
D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D013526:Surgical Mesh