TOTALLY PREPERITONEAL LAPAROSCOPIC INGUINAL HERNIORRHAPHY USING BALLOON DISTENSION

Background: After having performed over 200 transabdominal preperitoneal (TAPP) laparoscopic hernia repairs with no recurrences and no neuropathies, we recently changed to a totally preperitoneal repair due to the development of a balloon trocar that easily 'creates' the preperitoneal space. Methods: The totally preperitoneal operation is similar to our TAPP procedure in that it involves detailed delineation of Cooper's Ligament, spermatic cord and transversus abdominis arch with fixation of mesh to Cooper's ligament and arch for an anatomic tension-free hernia repair. Results: Our early experience consists of 60 hernia repairs in 50 patients (46 male, 4 female). There were 32 direct, 26 indirect and two femoral hernias. Eight hernias were recurrent. The operation takes approximately 1 h. There has been no morbidity. As with the TAPP procedure, minimal postoperative discomfort and return to regular activity within 2 to 3 days is the norm. Conclusions: We believe that the avoidance of the peritoneal incision and the attendant risks of intraabdominal adhesions associated with the TAPP procedure make the totally preperitoneal technique the preferred method of laparoscopic hernia repair.