Laparoscopic hernia repair: A review

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Abstract
Three principal approaches for laparoscopic herniorrhaphy are described. The most recent results are presented and discussed. The most popular current approach is the transabdominal pre-peritoneal prosthetic repair. This method involves laparoscopic access to the peritoneal cavity, incision of the peritoneum from within to access the pre-peritoneal plane, disposition of the hernial sac, placement of the mesh in the pre-peritoneal plane, and re-approximation of the peritoneal flap to provide a barrier between the mesh and the bowel. A second laparoscopic approach is the extraperitoneal operation. This involves a small incision below the umbilicus, tunnelling to develop the pre-peritoneal space without entering the peritoneum, disposition of the hernial sac, placement of mesh and closure. This approach is more difficult for the surgeon to learn compared with the transabdominal approach. The third approach - known as the intraperitoneal onlay mesh operation - is the easiest and fastest to perform but is also the most controversial. After laparoscopic evaluation of the hernia defect, mesh is placed and fixed directly on the peritoneum. This method should be considered as investigational, since long-term results and the potential for problems related to the presence of exposed mesh within the peritoneum are yet to be evaluated. Long-term results for the various laparoscopic hernia repairs are not yet available, but several authors are compiling series as the data become available. The longest follow-up periods are presently less than 2 years. Reported recurrence rates currently are 0% for the extraperitoneal approach, 0.6–0.8% for the transabdominal pre-peritoneal, and 3.2% for the intraperitoneal onlay mesh repair. Recurrence rates are usually higher for laparoscopic methods that do not use prosthetic mesh.

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