Results and Complications

Complication rates for inguinal hernia repairs are reported in most studies to occur in 7-12% of patients. Common complications include hematoma, infection, and scrotal swelling. Less common, but more serious complications include: testicu-lar atrophy, ischemic orchitis, leg swelling, pulmonary emboli, mesh infections, and paresthesias or numbness related to nerve entrapment or division.

Various studies report recurrence in 1 to 10% of primary inguinal hernia repairs and in 5-35% of recurrent inguinal hernia repairs. Mortality is reported in less than 1% of cases but can be as high as 13% in incarcerated or strangulated hernias.8

Laparoscopic repairs require knowledge of anatomy from within the pelvis. Misplaced staples can lead to unique complications. Staples should not be placed in the triangle of doom (ductus deferens medially and spermatic vessels laterally) since it contains the external iliac artery and vein as well as the femoral nerve. Special care should also be taken to avoid an accessory obturator artery that can cross Cooper's ligament. Staples should not be placed inferior to the iliopubic tract due to the risk of injury to the lateral femoral cutaneous or the femoral branch of the genitofemoral

nerve.

Table 16.1. Hernias

Name

Approach

Mesh vs. No Mesh

Tension vs. Tension Free

Method of Reinforcing Floor

Marcy repair

Open anterior

No mesh

Tension

No reinforcement of floor; internal ring narrowed with interrupted sutures10

Bassini repair

Open anterior

No mesh

Tension

Internal abdominal oblique, transverse abdominal, and

transversalis fascia are sutured to the shelving edge of the inguinal ligament with interrupted sutures (Sabiston)

Shouldice repair

Open anterior

No mesh

Tension

Same layers as Bassini, but with running imbricating sutures

McVay (Cooper

Open anterior

No mesh

Tension

Internal abdominal oblique, transverse abdominal, and

ligament) repair

transversalis fascia are sutured are sutured to pubic tubercle and Cooper's ligament medially then transitioned to the inguinal ligament laterally

Lichtenstein

Open anterior

Mesh

Tension free

Mesh patch sutured to pubic tubercle and shelving edge of the

repair

inguinal ligament laterally and to the conjoined tendon medially

Plug and

Open anterior

Mesh

Tension free

Hernia sac reduced and plug of mesh placed in defect and

patch

sutured with onlay mesh patch usually not sutured

Stoppa or

Open

Mesh

Tension free

Large mesh placed over the myopectineal oriface (bordered

GPRVS

preperitoneal

(Mersilene)

by pubis inferiorly, rectus medially, iliopsoas laterally, and internal abdominal oblique and transversus abdominis superiorly). No sutures. Held by intra-abdominal pressure."

TAPP

Laparoscopic transabdominal preperitoneal

Mesh

Tension free

Prosthetic mesh is tacked to consistent structures (Cooper's ligament, rectus muscle, transverse abdominis aponeurotic arch and the superior edge of the iliopubic tract).

TEPA

Laparoscopic

Mesh

Tension free

Prosthetic mesh is tacked to consistent structures (Cooper's

preperitoneal

ligament, rectus muscle, transverse abdominis aponeurotic arch and the superior edge of the iliopubic tract).

I POM

Laparoscopic intraperitoneal

Mesh

Tension free

Prosthetic mesh is tacked to consistent structures (Cooper's ligament, rectus muscle, transverse abdominis aponeurotic

arch and the superior edge of the iliopubic tract).

arch and the superior edge of the iliopubic tract).

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