An evidence-based approach for laparoscopic inguinal hernia repair: lessons learned from over 1,000 repairs". Review

Purpose. In this educational article we aim to provide a literature review on laparoscopic anatomy of the inguinal region. We would like to share the lessons learnt from the 1,194 laparoscopic hernia operations we have performed in sixteen years of experience, trying to provide an anatomical and physiological basis for surgeons. The current study reports a personal experience with a transabdominal pre-peritoneal (TAPP) hernioplasty procedure.Methods. A literature review using the keywords “hernia”, “laparoscopic approach” and “hernia repair”, was performed using the electronic biomedical database PubMed, Medline Extra, Embase, Biosis, Science Citation Index, Ovid, and text books.Between January 1994 and December 2010, a total of 1,194 patients, males and females (average age 56,7 years), underwent laparoscopic trans-abdominal pre-peritoneal (TAPP) inguinal hernia repair. Following reduction of the hernia sac and creation of the preperitoneal flap, a polypropylene mesh (10x16) and four spiral tacks were placed. Results and Conclusion. TAPP is easy to learn and perform. Through this approach a much better view from the inguinal anatomy is achieved and the procedure also offers a brief learning curve. Our patients reported minimal postoperative pain and returned to a normal life after 5 to 10 days, which is in accordance with the general anaesthesia series. During the follow-up period, 10% of seromas, 3% of scrotal haematomas, 1% of haemorrhages and 3% of recurrent hernias were observed. It should be emphasised that we have not observed abscess formation or acute infection related to the presence of mesh.