William C Streetman, MD, Karl LeBlanc, MD MBA FACS. Surgeons Group of Baton Rouge
The most frequently performed operation in general surgery is an inguinal hernia repair. Approximately 600,000 hernia repair operations are performed annually in the United States and as many as 15% of those repairs are estimated to be recurrent hernias. The optimal approach for a recurrent or bilateral inguinal hernia is still debatable. The laparoscopic approaches allow the surgeon to operate in relatively pristine tissue planes. The laparoscopic repair requires a set of skills to overcome the limitations of laparascopy and is associated with a steep learning curve and prolonged operative times but may be associated with less postoperative pain, quicker return to work and equivalent recurrence rates.
A literature review of pub med for recurrent and bilateral inguinal hernias was performed over the last seven years. Our primary focus was to compare the recurrence rates for the Lichtenstein, total extraperitoneal and transabdominal preperitoneal repairs. The complications of each group were also reported.
Eight studies (4 RCTs, 3 prospective studies, 1 retrospective study) were identified. The rates of recurrence ranged from 0-7% for the TEP, 3-19% for the TAPP, and 1-18% for the Lichtenstein repair. The laparoscopic patients returned to work sooner than the Lichtenstein patients. There was a bladder injury and two bowel injuries in the laparoscopic groups. Other complications were similar between the three repairs.
The laparoscopic repairs are safe and effective methods for treating recurrent and bilateral inguinal hernias. Some reports show that recurrences after open repairs occur later than laparoscopic repairs. This could be explained by technical errors and as surgeon experience with these types of repairs increases, the recurrence rates would be expected to decrease. The recurrence rates are equivalent to open repairs and the complication rates are similar also. We believe that the laparoscopic repair offers the patient a significant benefit for bilateral and recurrent inguinal hernia repairs.
Program Number: P321