The laparoscopic repair of inguino-femoral hernias has
had a tumultuous beginning in the surgical arena. Laparoscopic repairs have
had to compete with the current gold standard for anterior or conventional
inguinal hernia repairs. Initially, some of these laparoscopic repairs, such
as the "plug and patch" (PAP) and "on lay technique" (IPOM ), failed to
demonstrate good results and were abandoned. Only two laparoscopic repairs
have proven to be viable with early results comparable or superior to the
Liechtenstein repair. These repairs are the Extraperitoneal
Laparoscopic Repair (TEP) and the Trans-Abdominal
Preperitoneal Repair (TAPP). Some authors are now claiming newer and
simpler open laparoscopic inguinal hernia repairs such as "Plug" or "Klug"
Repair are effectively competing with the laparoscopic inguinal hernia
repairs without the increased cost. On our surgical service, the
laparoscopic inguinal hernia repair remain the best surgical modality for
the management of inguinal hernia. It is however a sophisticated technique
whose performance remains linked to the laparoscopic experience of
performing the surgeon.
Currently, the two most popular laparoscopic
techniques are the TAPP and the TEP.
The most ardent critique of the TAPP procedure is that
it is an intra-abdominal procedure with significant potential morbidity. On
the other hand, the TEP procedure avoids intra-abdominal access. In our
studies, the morbidity rate of both these laparoscopic repairs was minimal
and/or similar to other open repairs with comparable early recurrence rates.
The most persuasive argument for using this procedure is the same argument
favoring all laparoscopic procedures: the postoperative benefits to the
patients, i.e., less postoperative pain, decreased disability and small
incisions. However, it continues to be a procedure with limited long term
follow-up and analysis. We strongly believe surgeons performing laparoscopic
inguinal hernia repair should be familiar with the TEP and TAPP Repair.
Our surgical team developed an original TAPP repair in
the early nineties. This original technique was modified on several
occasions. Later, the TEP technique was introduced for patients who had
previously undergone major lower abdominal surgery. As of August 1, 2001,
over 2300 repairs were performed. Our technique and results are herein
reported.
