Total Extra Peritoneal Laparoscopic Inguinal Hernioplasty; Early Experience at the Royal Medical Services Hospitals of Jordan Armed Forces

Objectives: Laparoscopic inguinal hernia repair has been promoted as having significant advantages. The aim of this study is to evaluate the early results of total extra peritoneal laparoscopic inguinal hernia repair at the Royal Medical Services hospitals of Jordan Armed Forces. Methods: During the period between April 2004 to May 2006, 100 patients underwent total extra peritoneal laparoscopic inguinal hernia repair, the following data were collected; patient age, gender, side and type of hernia, intra-operative complications, conversion of the procedure to other type of repair, operative time, postoperative pain, hospital stay, postoperative complications, chronic pain and recurrence. Results: Out of the 100 patients, two patients (2%) were females and 98 (98%) were males. Age ranged between 16 and 79 years with a mean of 44.8 years. According to body mass index 22 (22%) patients were moderately obese. All of the patients were fit for general anesthesia. The 100 patients had 115 hernias, 53 (53%) on the right side, 32 (32%) on the left side and 15 (15%) bilateral. Sixty five (56.5%) hernia were indirect, 47 (40.9%) were direct and 3 (2.6%) were pantaloon hernia. Six (5.2%) of the hernias were recurrent. Operative time ranged between 35 to 165 minutes with a mean of 61.3 minutes, in the unilateral hernia the mean operative time was 56 minutes while in the bilateral cases it was 88 minutes. The procedure was converted to open repair in 2% of patients and to trans-abdominal preperitoneal laparoscopic repair in other 2% of patients. Intra-operative complications occurred in 5% of patients while post-operative complications occurred in 9% of patients all of which were mild. Post operative pain was assessed by the visual analogue scale twice; immediately after complete recovery from general anesthesia and in the first post operative day. In the first; it was severe in 9%, moderate in 81% and mild in 10% of patients, while in the second it was severe in 2%, moderate in 12% and mild in 86% of patients. Chronic pain occurred in 3% of patients. Recurrence occurred in 8 (8%) patients, six of them were from the first 50 cases. Conclusion: Our results in total extra peritoneal laparoscopic inguinal hernia repair were comparable to the results reported in literature regarding complication rate and recurrence rate especially after passing the first fifty cases indicating the effect of learning curve.