Transabdominal Pre-peritoneal Laparoscopic Hernia Repair Allows Diagnosis and Appropriate Treatment of Occult Bilateral Hernias

INTRODUCTION: Transabdominal pre-peritoneal (TAPP) laparoscopic repair has become established as a suitable primary treatment modality for inguinal hernias. The diagnosis and subsequent repair of occult bilateral hernias has been described by a number of authors. In this situation TAPP is thought to be superior to both open and extra-peritoneal laparoscopic repair because it avoids unnecessary dissection.
METHODS: A prospective review of patients undergoing TAPP hernia repairs by a single surgeon was carried out between October 2002 and September 2008. Intra-operative findings, with particular reference to occult bilateral hernias, were noted. Length of surgery, inpatient stay, body mass index (BMI) and post-operative follow up (satisfaction, complications and neuralgia) was also recorded.
RESULTS: 203 patients (199 male; 4 female; median age 55; range 17-90) underwent 267 TAPP laparoscopic repairs (143 unilateral; 62 bilateral; 34 recurrent). In 31 (15%) cases occult bilateral hernias were diagnosed at the time of laparoscopy. There was a median BMI of 25 kg/m2 in the series (range 19-33). Median hospital stay was 7 hours (range 3-48) with a median operating time of 38 minutes (range 18-67) for unilateral and 55 minutes (range 32-90) for bilateral hernias. All patients were satisfied with their repair at follow up (6 weeks). 20 (7%) patients developed complications (2 recurrences, 9 seromas, 3 haematomas, 3 superficial wound infections, 1 chest infection, 2 episodes of urinary retention.) 15 (5%) patients developed mild self-limiting neuralgia. There were no conversions to open procedure.
CONCLUSIONS: Laparoscopic TAPP inguinal hernia repair offers acceptably low complication rates, inpatient stay and operating time. With the added advantage of diagnosing occult bilateral hernias, we recommend it as the operation of choice for repair of inguinal hernias in suitable patients.


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Program Number: P456

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