Laparoscopic inguinal hernia repair

Lessons learned after 1224 consecutive cases

Bruce Ramshaw, F. W. Shuler, H. B. Jones, T. D. Duncan, J. White, R. Wilson, G. W. Lucas, E. M. Mason

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

Background: Despite numerous attempts to improve the techniques used for hernia repair, current published series show that recurrence rates are as high as 5-20%. The complexity of inguinal anatomy, combined with multiple potential areas of weakness, has contributed to the difficulty in preventing recurrences. However, the laparoscopic approach to inguinal herniorrhaphy has allowed clear visualization of all preperitoneal fascial planes and anatomic landmarks, as well as the hernia defect(s) and the peritoneal reflection. In the course of our performance of a series of 1,224 laparoscopic inguinal hernia repairs, we have developed a total extraperitoneal approach that yields excellent results with a low initial recurrence rate. Herein we describe our experience. Methods: After our initial 300 transabdominal preperitoneal (TAPP) hernia repairs, which resulted in six recurrences, two bowel injuries, one bladder injury, and six cutaneous nerve injuries, the total extraperitoneal approach (TEP) was adopted. Results: The first 300 TEP repairs resulted in one recurrence, two bowel injuries, one bladder injury, and two cutaneous nerve injuries. All major complications occurred in patients who had previous lower abdominal surgery. In the last 624 TEP herniorrhaphies we implemented some modifications to the technique, especially for patients with previous lower abdominal surgery. In this group we recorded one bladder injury, no cutaneous nerve injuries, and one recurrence. Conclusions: The total extraperitoneal approach for laparoscopic herniorrhaphy allows for a safe and effective repair with low rates of complication and recurrence. A thorough knowledge of the anatomy of the extraperitoneal space and especially the two- and three-dimensional inguinal anatomy of this space contributed greatly to the evolution of our technique.

Original languageEnglish (US)
Pages (from-to)50-54
Number of pages5
JournalSurgical Endoscopy
Volume15
Issue number1
DOIs
StatePublished - Feb 15 2001
Externally publishedYes

Fingerprint

Inguinal Hernia
Herniorrhaphy
Recurrence
Wounds and Injuries
Groin
Anatomy
Urinary Bladder
Skin
Anatomic Landmarks
Naphazoline
Hernia

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Ramshaw, B., Shuler, F. W., Jones, H. B., Duncan, T. D., White, J., Wilson, R., ... Mason, E. M. (2001). Laparoscopic inguinal hernia repair: Lessons learned after 1224 consecutive cases. Surgical Endoscopy, 15(1), 50-54. https://doi.org/10.1007/s004640001016

Laparoscopic inguinal hernia repair : Lessons learned after 1224 consecutive cases. / Ramshaw, Bruce; Shuler, F. W.; Jones, H. B.; Duncan, T. D.; White, J.; Wilson, R.; Lucas, G. W.; Mason, E. M.

In: Surgical Endoscopy, Vol. 15, No. 1, 15.02.2001, p. 50-54.

Research output: Contribution to journalArticle

Ramshaw, B, Shuler, FW, Jones, HB, Duncan, TD, White, J, Wilson, R, Lucas, GW & Mason, EM 2001, 'Laparoscopic inguinal hernia repair: Lessons learned after 1224 consecutive cases', Surgical Endoscopy, vol. 15, no. 1, pp. 50-54. https://doi.org/10.1007/s004640001016
Ramshaw, Bruce ; Shuler, F. W. ; Jones, H. B. ; Duncan, T. D. ; White, J. ; Wilson, R. ; Lucas, G. W. ; Mason, E. M. / Laparoscopic inguinal hernia repair : Lessons learned after 1224 consecutive cases. In: Surgical Endoscopy. 2001 ; Vol. 15, No. 1. pp. 50-54.
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