Laparoscopic Preperitoneal Inguinal Hernia Repair Using Preformed Polyester Mesh Without Fixation: Prospective Study With 1-year Follow-up Results in a Rural Setting

Abstract

To review our case series regarding the effectiveness, postprocedure pain, and cost of totally extraperitoneal (TEP) procedure for inguinal hernia repair, using a preformed polyester mesh (PEM), without fixation with additional anchoring devices. Prospective evaluation of all patients from March 2001 to July 2005 who underwent the above-described procedure in an outpatient setting in the rural southern United States using a preformed anatomic Parietex PEM with a minimum 1-year follow-up. All patients were evaluated at 1, 3-week, and 1-year postprocedure for recurrence, complications, and pain level assessment using a standardized questionnaire employing visual analog scale. A series of 108 patients consisting of 95 males and 13 females were operated on with a total of 157 hernias being repaired using laparoscopic techniques. The 1-year follow-up rate was 88.9% (n=96/108). Only 1 followed-up patient (n=1/96; 1.04%) or 0.71% (n=1/140) followed-up hernia repair had a recurrence after TEP repair noted at 1-week postoperative. Two patients had temporary urinary retention and there were no infectious complications or readmissions to the hospital. Visual analog scale pain score (0 to 10) at 1-month postprocedure averaged 0.37 and decreased to 0.03 at 1 year. The cost difference in our institution for all non-reusable material used in laparoscopic hernia repair was US $ 116.77 more than for an open procedure. This was primarily caused by higher costs for the laparoscopic mesh. Laparoscopic TEP inguinal hernia repair with preformed PEM without additional fixation can be performed in a rural community hospital setting with minimal long-term postoperative pain and the procedure results are comparable with larger centers with only marginally increased costs over open hernia repair.