Perioperative outcomes of laparoscopic total extraperitoneal inguinal hernia repair

Background: Laparoscopic total extraperitoneal (TEP) inguinal hernia repair has become increasingly common over the past decade due to reported reduced postoperative pain, shorter convalescence and lower incidence of long-term surgical related morbidity such as chronic pain and numbness. I However, the technique has not yet become standard of care in many institutions. The hesitation to adopt this approach may be related to the relatively long learning curve and limited high quality outcome data available. The purpose of this study was to evaluate perioperative morbidity and short-term outcomes of laparoscopic TEP repair. Methods: We performed a retrospective review of a consecutive series of patients who underwent laparoscopic TEP inguinal hernia repair over a 10-year period. Data collected included patient demographics, operative parameters and postoperative complications. Results: A total of 403 patients underwent laparoscopic TEP repair for the management of unilateral or bilateral inguinal hernia. The median age was 51 and 97% were males. The median BMI was 26 and 96% were ASA grade 1 or 2. Ninety-seven percent of repairs were primary, 15% were bilateral and 65% were indirect. The mean operative duration was 50 minutes over the entire study period, however this decreased significantly with time to a mean of 37 minutes in the final year. Postoperative complications occurred in 10.6%, 86% were Clavien-Dindo grade 1 and there were no significant visceral or vascular injuries. The most common complications were seroma formation (4.2%), urinary retention (3.7%) and rectus sheath haematoma (1.4%). Almost all patients were discharged within 24 hours. Conclusions: Laparoscopic TEP repair is a safe and well tolerated surgical treatment of inguinal hernia, associated with a low incidence of perioperative complications.