Laparoscopic Inguinal Hernia Repair: An Individualized Approach?

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Abstract
Objective: Recent reports have documented the safety and efficacy of laparoscopic hernia repair using polypropylene mesh. However, there is concern regarding the use of polypropylene mesh in young adults with small hernias. Individual laparoscopic hernia repair is proposed according to the Nyhus hernia classification. Methods: From November 1992 to August 1994, 123 patients with 140 hernias received laparoscopic treatment. All of the hernias were classified according to Nyhus. A standardized laparoscopic technique was used. In type-2 hernias, the inner ring was closed with nonabsorbable sutures without inserting mesh. In all type-3 and 4 hernias, large polypropylene mesh was preferred. Results: Of all hernias, 85.3% were primary, 15.7% recurrent and 12.1 % bilateral. 78% of patients were operated on under regional anesthesia, 13% were primarily intubated and 8% were intubated only because regional anesthesia had failed. The mean operating time for all hernias was 85 min (25-180 min). During the mean follow-up time of 23 months no early recurrence, mesh infection or bowel adhesions were detected. Peri-operative complications were seen in 7.3%, early postoperative complications in 19.3% and late postoperative complications in 3.2%. Most complications (like bleeding or nerve damage) occurred within the first 20 patients and can be explained as a steep learning curve. Conclusions: The early outcome after laparoscopic hernia repair seems similar to that of open hernia repair (Shouldice). According to the Nyhus classification inguinal hernias can be individually repaired without using mesh for all hernias.

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