title: Laparoscopic totally extraperitoneal inguinal hernia repair: twenty-seven serious complications after 4565 consecutive operations.
abstract: OBJECTIVE
  To identify and assess the complications of laparoscopic inguinal hernia treatment with totally extraperitoneal mesh placement (TEP).
  
  
  METHODS
  We included patients who had undergone the TEP procedure in a consecutive series of 4565 laparoscopic hernia repairs between January 2001 and January 2011. Inclusion criteria were diagnosis with symptomatic inguinal hernia, including recurrence after inguinal hernia repair and previous surgery in the lower abdomen and pelvis. All patients were 18 years of age or above. Patients with incarcerated hernia in emergency were excluded from the study.
  
  
  RESULTS
  A total of 4565 hernias were included in the study. In the group, there were 27 severe complications (0.6%): 12 bleedings (0.25%), two bladder lesions (0.04%), five intestinal obstructions (0.11%), four intestinal perforations (0.09%) one injury to the iliac vein (0.02%), one femoral nerve injury (0.02%), two lesions of vas deferens (0.04%) and two deaths (0.02%) (pulmonary embolism, peritonitis).
  
  
  CONCLUSIONS
  The rate of complications with the TEP procedure is low. Laparoscopic hernia repair technique is reproducible and reliable. In our experience, there are contraindications to the TEP procedure. TEP technique must be meticulous to avoid intraoperative complications (bipolar diathermy). Complications can occur even after the surgeon has gained substantial experience.
authors.affiliation: Department of Surgery, Prof. Edmundo Vasconcelos Hospital, São Paulo, Brazil. almmeyer@yahoo.com
authors.forename: Alberto
authors.initials: A
authors.lastname: Meyer
authors.forename: Pierre
authors.initials: P
authors.lastname: Blanc
authors.forename: Jean Gabriel
authors.initials: JG
authors.lastname: Balique
authors.forename: Masaya
authors.initials: M
authors.lastname: Kitamura
authors.forename: Ramon Trullenque
authors.initials: RT
authors.lastname: Juan
authors.forename: Franck
authors.initials: F
authors.lastname: Delacoste
authors.forename: Jérôme
authors.initials: J
authors.lastname: Atger
mesh_terms: D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010537:Peritoneum; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013526:Surgical Mesh