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Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Since November 1990, 50 laparoscopic herniorrhaphies have been done in 47 patients (three patients with bilateral repairs), including 31 indirect and 19 direct inguinal hernias, three of which were recurrent. The 47 patients included 42 men and five women. Small indirect hernias were treated by plugging the hernia orifice with a tightly rolled polypropylene mesh plug. Large indirect, all direct, and combined hernias were treated by creating a peritoneal flap and stapling a polypropylene mesh screen preperitoneally over the defect. The mesh was stapled to Cooper's ligament, iliopubic tract, and transversus abdominous arch. Forty-five patients were discharged on the day of surgery and the other two within 24 h. The average return to full activity has been two days. The only intraoperative complication was an easily controlled trocar site bleeder. Postoperatively one minor trocar site infection occurred. One persistent and one recurrent hernia were among the group, both large indirect hernias done early in our experience (by the plug technique) before stapling instruments were available. The technique of laparoscopic herniorrhaphy is in its infancy and still evolving as our understanding of anatomy and technology improves. Even if long-term follow-up shows an acceptable recurrence rate and less patient disability, surgeons must weigh the wisdom of converting a procedure from local to general anesthesia and an inexpensive procedure into a more expensive procedure.
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PMID:Preliminary evaluation of laparoscopic herniorrhaphy. 826 26

The routine use of mesh for repair of inguinal hernia has been popularized by Lichtenstein and others. Although preperitoneal placement is more appealing than the onlay technique, the classical approach by Nyhus and Condon is difficult under local anesthesia and denervates the inguinal muscles to some degree. Preperitoneal mesh may become the standard for inguinal hernia as the laparoscopic approach becomes more popular. This report describes the author's first 100 hernia repairs done using a simplified preperitoneal approach under local anesthesia. The preperitoneal space is entered directly through the posterior floor, but a complete covering of the direct, indirect, and femoral spaces is accomplished similar to an open technique. After placement of the mesh, a truly "tension-free" closure of the posterior floor can be accomplished. Patients are discharged home in 1 to 2 hours. Because a standard approach and block are used, the learning curve for this operation should be brief compared with that of the laparoscopic method. The follow-up of this series is short (average: 15 months), but there have been no recurrences or infections. One patient returned to the operating room within 4 hours due to an arterial bleeder in Scarpa's fascia but was discharged that day and had no subsequent problems. Another patient has a postoperative neuralgia probably unrelated to the mesh. Otherwise, there has no complications with the placement of the Marlex mesh. Patients are allowed to return to full activity and work at their discretion.
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PMID:Simplified preperitoneal Marlex hernia repair. 848 44