Indirect Inguinal Hernia; Laparoscopic view
Laparoscopic inguinal hernia repair originated in the early 1990s as laparoscopy gained a foothold in general surgery. Inguinal hernias account for 75% of all abdominal wall hernias, and with a lifetime risk of 27% in men and 3% in women. Repair of these hernias is one of the most commonly performed surgical procedures in the world. In the United States, approximately 800,000 inguinal herniorrhaphies are performed annually.
Although open, mesh-based, tension-free repair remains the criterion standard, laparoscopic herniorrhaphy, in the hands of adequately trained surgeons, produces excellent results comparable to those of open repair. In a comparison between open repair and laparoscopic repair, Eklund et al found that 5 years after operation, 1.9% of patients who had undergone laparoscopic repair continued to report moderate or severe pain, compared with 3.5% of those who had undergone open repair.
A number of studies have shown laparoscopic repair of inguinal hernias to have advantages over conventional repair, including the following:
• Reduced postoperative pain
• Diminished requirement for narcotics
• Earlier return to work
Laparoscopic repair has some disadvantages as well, including the following:
• Increased cost
• Lengthier operation
• Steeper learning curve
• Higher recurrence and complication rates early in a surgeon’s experience