There are a variety of accepted techniques for
herniorrhaphy. With the advent of laparoscopic general surgery, laparoscopic transabdominal and total extraperitoneal techniques have been added to the many options for repair of the
inguinal hernia. From 5/91 to 6/93 we had performed 290 transabdominal preperitoneal (
TAPP) laparoscopic
herniorrhaphies on 244 adult patients. Due to concerns of potential early and late complications associated with entering the abdominal cavity, we adopted the total extraperitoneal approach (
TEPA) for laparoscopic
herniorrhaphies in 6/93. Between 6/93 and 12/93, 118
hernias have been repaired in 95 patients using the total extraperitoneal approach. In a retrospective comparison between these two procedures, the recurrence rate is 1.7% (5/290) for
TAPP herniorrhaphies and 0% (0/118) for the
TEPA. The overall complication rate for
TAPP herniorrhaphies was 11.1% and included thigh
paresthesias (6), inferior epigastric artery
injuries (4), enterotomy (1), bowel obstruction (1), bladder injury (1), and
urinary retention (14). The overall complication rate for the
TEPA was 3.2% and included bladder injury (1), and
urinary retention (2). Mean
operative time was similar between these groups (
TAPP-81.2 minutes,
TEPA-92.9 minutes).