Sliding Inguinal Hernias: Scope of Laparoscopic Repair

Abstract

Sliding hernias are an uncommon type of inguinal hernia. Very little is published in the literature regarding the outcome of laparoscopic repair of sliding hernia. The present series evaluates the feasibility and outcome of laparoscopic repair of these hernias. Retrospective analysis of prospectively maintained data of patients with sliding inguinal hernia undergoing laparoscopic repair from January 2003 to July 2010 was done. The patient demographics, clinical presentations, operative details, and complications were studied. Related literature was reviewed. A total of 1136 patients underwent laparoscopic repair of inguinal hernia, of which 54 patients had sliding inguinal hernia (4.7%). Forty-one patients (76%) had left-sided hernia and 13 patients (24%) had right-sided hernias. Mean age of presentation was 63.5 years. Thirty-five patients (64.8%) presented as complicated hernias (27 irreducible, 7 obstructed, and 1 strangulated). Thirty-nine patients had sigmoid colon, 9 patients had cecum, 3 patients had ascending colon, and 3 patients had urinary bladder as the sliding component. Eight patients underwent Lichtenstein repair, 27 patients transabdominal preperitoneal repair, and 19 patients total extraperitoneal repair. Mean operating time of laparoscopic repair was 53 minutes (40-105 minutes). Five procedures (10.8%) were converted to open repair. Overall morbidity was 44.4%. Median hospital stay was 1.5 days (1-14 days). There were no recurrences in up to 7 years follow-up. Laparoscopic repair of sliding inguinal hernia is feasible and safe with good outcome. Laparoscopic transabdominal preperitoneal approach is the preferable method.