title: Totally extraperitoneal laparoscopic inguinal hernia repair is a safe option in patients with previous lower abdominal surgery.
abstract: BACKGROUND
  History of inguinal hernia repair changed over the decades from repair by tissue approximation to the insertion of synthetic mesh and the introduction of laparoscopic repair. Despite accounting for 15-20% of hernia operations worldwide, many surgeons considered previous lower abdominal surgery as a contraindication to performing totally extraperitoneal (TEP) repair.
  
  
  OBJECTIVE
  The aim of this study was to assess the feasibility of TEP in primary and recurrent inguinal hernias in patients with previous lower abdominal surgery.
  
  
  METHODS
  This study was a retrospective review of patients who underwent TEP inguinal hernia repair from January 2001 to July 2005. Variables studied included patient demographics, type of hernia, type of previous surgery, conversion to open repair, postoperative complications, and overnight admission.
  
  
  RESULTS
  One hundred eight patients (107 males, 1 female), with a median age of 55 years (range 87-24), underwent TEP repair. Ninety-four patients had primary inguinal hernias, and 13 patients had recurrent inguinal hernias. Seventeen patients had a previous lower abdominal surgery (13 primary and 4 recurrent inguinal hernias). There was 1 conversion to open repair and 1 case of postoperative bleeding that required an exploration-both in the group with no previous surgery. Postoperative complications were minimal. All cases were performed as day cases; however, patients with recurrent hernia stayed longer in the hospital than those with primary hernia (P = 0.006).
  
  
  CONCLUSIONS
  TEP repair is feasible in patients with previous lower abdominal surgery. TEP was planned as a day-case procedure; however, patients with recurrent hernias needed a planned admission, as an overnight stay was required.
authors.affiliation: Our Lady's Hospital-Navan, Dublin, Ireland.
authors.forename: Osama
authors.initials: O
authors.lastname: Al-Sahaf
authors.forename: Dhafir
authors.initials: D
authors.lastname: Al-Azawi
authors.forename: Muhammad Z
authors.initials: MZ
authors.lastname: Fauzi
authors.forename: Frank O
authors.initials: FO
authors.lastname: Cunningham
authors.forename: Joseph P
authors.initials: JP
authors.lastname: McGrath
mesh_terms: D000005:Abdomen / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies