What should be the correct indications for laparoscopic inguinal hernia repair?

Abstract

We read with great interest the article entitled ‘‘A modified laparoscopic hernioplasty (TAPP) is the standard procedure for inguinal and femoral hernias: a retrospective 17-year analysis with 1,123 hernia repairs’’ by Peitsch [1]. Peitsch analyzed retrospectively 5,764 patients who had undergone hernia repair surgery 2–17 years earlier at one large center. His report discussed the transabdominal preperitoneal (TAPP) approach for treating incarcerated hernias, scrotal hernias, and hernias after radical prostatectomy, as well as recurrent hernias after TAPP and totally extraperitoneal (TEP) procedures (complex hernias). He concluded that a modified TAPP procedure with suturing of hernia defects larger than 1 9 1 cm can be used as the standard procedure without recurrences for femoral hernias, incarcerated hernias, and hernias after radical prostatectomy, and for scrotal hernias with low recurrence rates [1]. Several studies have shown that laparoscopic hernia repair is a safe, efficient method and offers the advantages of minimally invasive surgery such as less postoperative pain, faster return to normal activities, and less long-term complications like chronic pain and numbness. Despite these advantages, the recurrence rate was similar to those of classic open tension-free mesh techniques [2]. However, the mesh that is used in laparoscopic hernia repair can cause an intense fibrotic reaction that makes the dissection to expose the endopelvic fascia difficult, causes difficulties in the surgery of pelvic organs (e.g., prostate, bladder) and is a potential complicating factor in subsequent kidney transplantation [3–5]. Based on clinical experience and the literature, we believe that the patients scheduled for laparoscopic inguinal herniorrhaphy with mesh should be screened for prostate and bladder cancer and also for chronic renal failure. This procedure should be considered in a comprehensive manner and the indications should be determined correctly. In his study, Peitsch did not discuss in detail whether the patients who had undergone laparoscopic inguinal hernia repair had risk factors for pelvic surgery or renal transplantation. We believe that our opinion will contribute to this valuable article.