Laparoscopic Hernioplasty Update

Abstract

ABSTRACT

The Toy-Smoot laparoscopic hernioplasty has been performed on 75 patients with a total of 83 hernioplasties over the past 20 months. Sixty-nine patients were male and six were female. The age range was 20 to 75 years with an average age of 51.5 years. Twelve of the patients had bilateral hernias repaired: 55 direct hernias, 16 indirect hernias, and 5 pantaloon hernias. Eleven of the repairs were for recurrent hernias. The procedure was performed under general anesthesia. The abdomen was insufflated with carbon dioxide, establishing the pneumoperitoneum. Three 11 mm trocars were inserted, the first via the umbilicus, into which the 0° endoscope was inserted. Two additional trocars were inserted at the level of the umbilicus at the anterior axillary lines. The hernia sacs were left in situ. The medial umbilical ligament was dissected medially, so as to identify directly the pubic tubercle and the Cooper's ligament. An expanded PTFE soft tissue patch, 1 mm thick and 7.5 × 10 cm in size, was attached to the Nanticoke Endo-patch spreader and introduced via the contralateral trocar and positioned over the hernia defect. The Endopath EMS stapler was then used to secure the PTFE patch over the hernia defect. This required secure anatomical fixation to the transversalis fascia anteriorly and laterally, the pubic tubercle, and the posterior rectus sheath, medially, Cooper's ligament, posteromedially, and the endoabdominal fascia, posterolaterally. There were a total of seven different complications, one major, which was a bladder injury that required an open repair of the bladder and then an open, conventional hernioplasty. The other, more minor complications were urinary retention, hydrocele formation, pubic ostitis, anterior thigh pain, scrotal hematoma, and rectus sheath hematoma, all of which resolved spontaneously by the third postoperative week. All the procedures were done as outpatients. Postoperative pain and discomfort were minimal. Normal activity, including heavy, manual labor, was resumed on the third to fourth postoperative day. The patients took an average of 6 Percocets total postoperatively. With the maximum follow-up now of 20 months, two recurrences have been noted which were in the first patient and the ninth patient early in the evolution of the procedure, giving a 2.4% recurrence rate. There have been no recurrences in the past 14 months.