A comparison of the approaches to laparoscopic herniorrhaphy.

Background: There are a variety of accepted techniques for herniorrhaphy. With the advent of laparoscopic general surgery, new endoscopic techniques using the transabdominal and total extraperitoneal approaches have been added to the many options for the repair of inguinal hernia. The purpose of this study was to compare the early results of these approaches at a single institution.
Methods: Between May 1991 and August 1994, 600 laparoscopic herniorrhaphies were performed on 493 patients. Three hundred hernias were repaired using the transabdominal preperitoneal approach and 300 were repaired using the total extraperitoneal approach. A retrospective review was performed with emphasis on the comparison of recurrence rates and complication rates between these two approaches to laparoscopic herniorrhaphy.
Results: The recurrence rates were 2.0% (6/300) for the transabdominal approach and 0.3% (1/300) for the total extraperitoneal approach. The complication rate for the transabdominal approach was 10.7% and included thigh paresthesias (6), inferior epigastric artery injuries (4), enterotomy (1), bowel obstruction (1), bladder injury (1), and urinary retention (14). The complication rate for the total extraperitoneal approach was 3.7% and included enterotomies (2), bladder injury (1), paresthesia (1), and urinary retention (6). The recurrence, the enterotomies, and the bladder injury in the total extraperitoneal group were all in patients who had previous lower abdominal operations.
Conclusions: Although both the transabdominal preperitoneal and total extraperitoneal approaches to laparoscopic herniorrhaphy have acceptable recurrence and complication rates, there were significant advantages to the total extraperitoneal approach in our institution. Previous lower abdominal surgery may be a relative contraindication to the total extraperitoneal approach.