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Objective

Objective. In Japan, laparoscopic inguinal herniorrhaphy(LH) is not popular. We performed a retrospective study to evaluate the results of LH in our hospital. Patients. Between August 1992 and February 2008, 286 patients with 315 hernias were operated on at our department. 1. 2.

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Objective

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  1. Objective In Japan, laparoscopic inguinal herniorrhaphy(LH) is not popular. We performed a retrospective study to evaluate the results of LH in our hospital. Patients Between August 1992 and February 2008, 286 patients with 315 hernias were operated on at our department.

  2. 1 2 3 Standard method of LH in our hospital Transabdominal preperitoneal approach Veress needle is inserted via umbilicus Trocar size umbilicus:5mmright:5mmleft:3mm Umbilicus：30°laparoscope Right：scissors, forceps, needle holder introduction of mesh and tacker Left：forceps Mesh：polyester or polypropylene soft 　　　（average size:14×9cm） 1.umbilicus 2.right flank 3.left flank

  3. The advantage-1 1. Improved cosmesis LH Postoperative 7 months Open repair Postoperative 2 years

  4. The advantage-2 2. Less postoperative pain Earlier return to normal activity Less chronic postoperative pain 《meta-analysis of randomized control trial》 ・less postoperative pain, more rapid return to normal activity The EU Hernia Trialists Collaboration:Br J Surg 87:860-867, 2000 ・less persisting pain The EU Hernia Trialists Collaboration: Ann Surg 23:322-332, 2002 ・lower incidence of chronic pain Schmedt CG, et al: Surg Endosc 19:188-199, 2005

  5. The advantage-3 3. Initial visualization of a recurrent hernia defect 　（the avoidance of scar tissue dissection around the area of the previous repair） hernia defect hernia defect plug Lt. direct hernia after Mesh-plug repair

  6. The advantage-4 4. Initial visualization of a combined hernia defect rt. direct hernia rt. indirect hernia Rt. combined hernia

  7. The advantage-5 5. No additional incision to treat bilateral hernias • 《 prospective randomized controlled clinical study 》 • With relation to open tension-free repair • ・higher cost • ・less postoperative pain • ・earlier return to work Sarli L.et al.: Surg Laparosc Endosc Percutan Tech 11:262-267, 2001

  8. The advantage-6 6. Evaluation of incarcerated hernia（in TAPP） hernia defect hernia defect ovary small bowel uterine tube Rt. femoral hernia Rt. indirect hernia

  9. The advantage-7 7. Diagnosis of unsuspected contralateral hernia（in TAPP） ※In our practice, it is 3.8%（11/286）. ・The reported laparoscopically detected incidence of occult contralateral hernias is between 11.2% and 50%. Koehler RH.: Surg Endosc 16:512-520, 2002

  10. The disadvantage-1 1. Increased operative cost（general anesthesia, equipment） But ・The total cost for working patients are lower with the laparoscopic technique, when the cost of lost work days is factored into overall expense. Heikkinen T. et al: Surg Endosc 12:1199-1203, 1998 ・From a societal perspective, laparoscopic approach can be a cost-effective treatment option for inguinal hernia repair. Stylopoulos N. et al: Surg Endosc 17:180-189, 2003

  11. The disadvantage-2 2. Specific training and long learning curve Learning curve is ・30–50 cases DeTurris SV. et al: J Am Coll Surg 194:65-73, 2002 ・40 procedures Lim M. et al: Surg Endosc 20:1453-1459, 2006 ※ Some authors have quantified the LH learning curve at 30–250 hernia repairs.

  12. The disadvantage-3 3. Major complications and recurrences during the learning curve ※We experienced two severe complications. （one bladder injury and one trocar site hernia） 〔 Reported serious complications 〕 ・visceral injury (bladder, intestine, etc.） ・vascular injury （iliac artery, etc.） ・ trocar site hernia ・ bowel obstruction 　 ・ testicular ischemia ・ nerve injury （genitofemoral nerve, etc.）

  13. Conclusions Laparoscopic herniorrhaphy has many advantages for both experienced surgeons and patients. 2. The widespread adoption of laparoscopic herniorrhaphy needs cost saving and surgeon’s technical skill.

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