Total extraperitoneal preperitoneal laparoscopic hernia repair using spinal anesthesia.

BACKGROUND: Laparoscopic herniorrhaphy is a well-debated approach to inguinal hernia repair. Multiple technical and outcome variables have been compared with those of traditional open inguinal hernia repairs. One of these variables is the choice of anesthesia. To date, no reports describe the use of spinal anesthesia for laparoscopic hernia repairs. We present herein a review of our experience with spinal anesthesia for the total extraperitoneal preperitoneal laparoscopic hernia repair (TEP). METHODS: We prospectively reviewed 30 patients undergoing TEP while under spinal anesthesia. Methods of anesthesia, surgical procedure, operative and anesthesia delivery times, as well as outcomes were reviewed. Patients were followed up over a 2-year period. Short- and long-term results of the surgical procedure and anesthesia delivered were noted. RESULTS: All patients underwent successful laparoscopic hernia repair while under spinal anesthesia without conversion to general anesthesia. Forty-four hernias were repaired in 30 patients. Short- and long-term follow-up (2 years) revealed no significant untoward affects from the spinal anesthesia in this series of patients. Aside from inguinodynia in 3 patients in the short-term, no other short-term or long-term untoward sequelae occurred. CONCLUSIONS: Spinal anesthesia is a feasible, and in our experience, the preferable method of anesthesia for total extraperitoneal laparoscopic hernia repair.     

Transabdominal preperitoneal versus totally extraperitoneal repair of inguinal hernia: a meta-analysis of randomized studies

Background

The aim of the present study was to comparatively evaluate the outcomes of laparoscopic transabdominal preperitoneal inguinal hernia repair and totally extraperitoneal repair.

Methods

The electronic databases of Medline, EMBASE, and the Cochrane Central Register of Controlled Trials were searched, and a meta-analysis of randomized clinical trials was undertaken.

Results

Seven studies comprising 516 patients with 538 inguinal hernia defects were identified. A shorter recovery time (P = .02) was found for totally extraperitoneal repair in comparison with transabdominal preperitoneal inguinal hernia repair (weighted mean difference = −.29; 95% confidence interval [CI], −.71 to .07) although the length of hospitalization (P = .89) was similar in the 2 treatment arms (weighted mean difference = .01; 95% CI, −.13 to .15). Operative morbidity (P = .004) was higher for the preperitoneal approach (odds ratio = 2.15; 95% CI, 1.29 to 3.61). No differences were found with regard to the incidence of recurrence, long-term neuralgia, and operative time.

Conclusions

Current evidence suggests similar operative results for endoscopic and laparoscopic inguinal hernia repair, with a trend toward higher morbidity for the preperitoneal approach. Randomized trials with a longer-term follow-up are needed in order to assess the effect of each approach on the prevention of recurrence.     

Meta-analyses of randomized controlled trials of laparoscopic vs conventional inguinal hernia repairs

Background: Despite randomized controlled trials, the merits of laparoscopic hernia repair remain poorly defined. A meta-analysis may provide a timely overview. Methods: An electronic MEDLINE search, supplemented by a manual search, yielded 14 randomized controlled trials with usable statistical data, involving 2,471 patients. The trials were grouped for separate meta-analyses according to the control operation, either a tension-free or sutured repair, used for comparison. The effect sizes for operating time, postoperative pain, return to normal activity, and early recurrence were calculated, using a random-effects model when the effect sizes were heterogeneous and without subcategories. Results: In all meta-analyses, the laparoscopic operation was significantly longer. When compared with tension-free repairs, the laparoscopic operation showed no advantage in terms of postoperative pain, but resulted in a shorter recovery (marginal significance). As compared with sutured repair, both postoperative pain and recovery were in favor of the laparoscopic operation. When all 14 trials were analyzed together, laparoscopic repairs still had moderately reduced postoperative pain and recovery time. Conclusions: Laparoscopic hernia repair has a modest advantage over conventional repairs. This advantage is more apparent when laparoscopic repairs are compared with sutured repairs rather than tension-free repairs. Received: 9 June 1998/Accepted: 12 January 1999     

Effect of prosthetic material on adhesion formation after laparoscopic ventral hernia repair in a porcine model

Intraperitoneal placement of prosthetic mesh causes adhesion formation after laparoscopic incisional hernia repair. A prosthesis that prevents or reduces adhesion formation is desirable. In this study, 21 pigs were randomized to receive laparoscopic placement of plain polypropylene mesh (PPM), expanded polytetrafluoroethylene (ePTFE), or polypropylene coated on one side with a bioresorbable adhesion barrier (PPM/HA/CMC). The animals were sacrificed after 28 days and evaluated for adhesion formation. Mean area of adhesion formation was 14% (SD±15) in the PPM/HA/CMC group, 40% (SD±17) in the PPM group, and 41% (SD±39) in the ePTFE group. The difference between PPM/HA/CMC and PPM was significant (P=0.013). A new visceral layer of mesothelium was present in seven out of seven PPM/HA/CMC cases, six out of seven PPM cases, and two out of seven ePTFE cases. Thus, laparoscopic placement of PPM/HA/CMC reduces adhesion formation compared to other mesh types used for laparoscopic ventral hernia repairs.This work was presented as an oral presentation at the American Hernia Society Meeting, Tucson, Ariz. USA in May, 2002.This study was funded by a grant from Genzyme, Corp., Cambridge, Mass. USA     

Laparoscopic extraperitoneal inguinal hernia repair

We have devised a reproducible approach to the preperitoneal space for laparoscopic repair of inguinal hernias that is based on an understanding of the abdominal wall anatomy. Laparoscopic totally extraperitoneal herniorrhaphy was performed on 99 hernias in 90 patients at the Los Angeles County–University of Southern California Medical Center, using a standardized approach to the preperitoneal space. Operative times, morbidity, and recurrence rates were recorded prospectively. The median operative time was 37 min (range, 28–60) for unilateral hernias and 46 min (range, 35–73) for bilateral hernias. There were no conversions to open repair, and there was only one conversion to a laparoscopic transabdominal approach. Complications were limited to urinary retention in two patients, pneumoscrotum in one patient, and postoperative pain requiring a large dose of analgesics in one patient. All patients were discharged within 23 h. There were no recurrences or neuralgias on follow-up at 2 years. A standardized approach to the preperitoneal space based on a thorough understanding of the abdominal wall anatomy is essential to a satisfactory outcome in hernia repair. Received: 18 November 1998/Accepted: 19 March 1999     

硬膜外麻醉下腹腔镜全腹膜外疝修补术治疗成人腹股沟疝体会

目的总结硬膜外麻醉下腹腔镜全腹膜外疝修补术（TEP）的优点。探讨TEP手术的安全性、可行性、有效性及手术方法。方法回顾性分析26例腹股沟疝患者行TEP手术的临床资料。直疝6例,斜疝20例。单侧疝22例,双侧疝4例,其中复发疝2例。结果 26例腹股沟疝患者手术均成功,包括双侧疝共进行30例次TEP手术,均在40～110min完成,住院天数3～8d,平均4.6d。术后有1例出现阴囊内血肿,2例出现腹股沟区疼痛。随访3～12个月,无一例复发。结论硬膜外麻醉下行TEP具有手术安全可靠、对腹腔干扰小,术后恢复快、住院时间短,疼痛发生少、复发率低等优点。     

腹腔镜下经腹腹膜前疝无张力修补术治疗隐匿性疝的临床研究

目的 探讨腹腔镜下经腹腹膜前疝无张力修补术治疗隐匿性腹股沟疝的临床疗效,减少单侧腹股沟疝术后对侧假性复发的发生率.方法 回顾性分析南昌大学第二附属医院胃肠外科2017年1 月至2019年7月收治的单侧腹股沟疝行手术治疗的2 155 例病人,其中1 105 例病人行开放性疝修补术,927例病人行腹腔镜经腹腹膜前疝修补术(...     

Adhesions after laparoscopic inguinal hernia repair

Prosthetic mesh for laparoscopic inguinal hernia repair has become popular but the method of its placement is controversial. Mesh placed within the peritoneum may cause adhesion formation and further complications. The aim of this study was to examine the laparoscopic placement of a mesh, comparing intraperitoneal vs extraperitoneal insertion. In a porcine model (n=15) a polypropylene mesh was placed laparoscopically over the anterior abdominal wall. On the left side the mesh was stapled on the parietal peritoneum. On the right side the peritoneum was incised, an extraperitoneal space was dissected, the mesh was inserted, and the peritoneum was closed over it. The animals were maintained for 2 weeks. At postmortem there were adhesions in two of those placed extraperitoneally and five of those placed intraperitoneally (P=0.19, Fisher's exact test). The adhesions comprised fibrous peritoneal bands to loops of small intestine. Both methods of laparoscopic mesh placement were associated with a small but significant incidence of adhesion formation.Paper based on a communication to the European Association for Endoscopic Surgery in Cologne, Germany, June 1993     

Adhesion formation is reduced after laparoscopic surgery

Background: Adhesion formation after abdominal operations causes significant morbidity. Methods: Adhesion formation in pigs was compared after placement of prosthetic mesh during celiotomy (group 1), laparoscopy with large incision (group 2), and laparoscopy (group 3). After peritoneum was excised, polypropylene mesh was fixed to the abdominal wall, then to the opposite abdominal wall in the preperitoneal space followed by peritoneal closure. Adhesion area, grade, and vascularity were measured. Results: More adhesions (p < 0.02) covered intraperitoneal mesh (7.57 ± 1.89 cm²) than covered reperitonealized mesh (2.16 ± 1.13 cm²), and adhesion grade was significantly greater (p < 0.02). Adhesion areas were significantly greater in groups 1 and 2 than in group 3 (p= 0.001 and 0.03, respectively). Adhesion grade was significantly greater in groups 1 and 2 than in group 3 (p= 0.02 and p= 0.04, respectively). Groups 1 and 2 had more vascular adhesions than group 3 (p < 0.01 and p= 0.02, respectively) Conclusions: A foreign body within the peritoneum stimulates more numerous and denser adhesions. Tissue trauma distant from the site of adhesions increases their formation. A major advantage of laparoscopic surgery is decreased adhesion formation. Received: 23 January 1998/Accepted: 10 March 1998     

Endoscopically guided percutaneous repair of inguinal hernia through a 2-cm incision

Background: The laparoscopic repair of inguinal hernia is still controversial. Transabdominal preperitoneal repair violates the peritoneal cavity and may result in visceral injuries or intestinal obstruction. The laparoscopic extraperitoneal approach has the disadvantage of being technically demanding and requires extensive extraperitoneal mobilization. The Lichtenstein repair gives good long-term results, is easy to learn, can be performed under local anesthesia, but requires a larger incision. Methods: We describe a novel percutaneous tension-free prosthetic mesh repair performed through a 2-cm groin incision. The inguinal canal is traversed with the aid of a 5-mm video-endoscope and the canal is widened using specially designed balloons. Spermatic cord mobilization, identification and excision of the indirect sac, and posterior wall repair are carried out under endoscopic guidance. Results: Between October 1993 and July 1995, 85 primary inguinal hernia repairs (48 indirect and 33 direct) were performed on 81 patients (80 men, one woman) by the author (A.D.). The mean age was 41 years (range 17–83 years). Six repairs were performed under local anesthetic. Mean operative time was 42 min (range 25–74). Mean hospital stay was 1.2 days (0–3 days). The mean return to normal activity was 8 days (2–10 days). Eight complications have occurred: a serous wound discharge, two scrotal hematomas, a scrotal swelling that resolved spontaneously, wound pain lasting 2 weeks, an episode of urinary retention, and two recurrences early in the series (follow-up 1–22 months). Conclusion: The endoscopically guided percutaneous hernia repair avoids the disadvantages of laparoscopy (i.e., lack of stereoscopic vision, reduced tactile feedback, unfamiliar anatomical approach, risk of visceral injury), yet the use of endoscopic instrumentation allows operation through a 2-cm incision. The minihernia repair thus combines the virtues of an open tension-free repair with minimal access trauma. Received: 21 May 1996/Accepted: 8 August 1996     

Perioperative outcomes and complications of open vs laparoscopic extraperitoneal inguinal hernia repair in a mature surgical practice

Background: Although the laparoscopic totally extraperitoneal (TEP) approach to hernia repair has been associated with less pain and a faster postoperative recovery than traditional open repair, many practicing surgeons have been reluctant to adopt this technique because of the lengthy operative times and the learning curve for this procedure. Methods: Data from all patients undergoing TEP repair since 1997 and open mesh repair (OPEN) since 1999 were collected prospectively. Selection of surgical approach was based on local hernia factors, anesthetic risk, previous abdominal surgery, and patient preference. Statistical analyses were performed using unpaired t-tests and chi-squared tests. Data are mean ± SD. Results: TEP repairs were performed in 147 patients and open repairs in 198 patients. Patients in the OPEN group were significantly older (59 ± 19 years OPEN vs 51 ± 13 years TEP) and had a higher ASA (1.9 ± 0.7 OPEN vs 1.5 ± 0.6 TEP; p < 0.01). TEP repairs were more likely to be carried out for bilateral (33% TEP, 5% OPEN) or recurrent hernias (31% TEP, 11% OPEN) than were open repairs (p < 0.01). Concurrent procedures accompanied 31% of TEP and 12% of OPEN repairs (p < 0.01). Operative times (min) were significantly shorter in the TEP group for both unilateral (63 ± 22 TEP, 70 ± 20 OPEN; p = 0.02) and bilateral (78 ± 27 TEP, 102 ± 27 OPEN; p = 0.01) repairs. Mean operative times decreased over time in the TEP group for both unilateral and bilateral repairs (p < 0.01). Patients undergoing TEP were more likely (p < 0.01) to develop urinary retention (7.9% TEP, 1.1% OPEN), but were less likely (p < 0.01) to have skin numbness (2.8% TEP, 35.8% OPEN) or prolonged groin discomfort (1.4% TEP, 5.3% OPEN). Conclusions: Despite a higher proportion of patients undergoing bilateral repairs, recurrent hernia repair, and concurrent procedures, operative times are shorter for laparoscopic TEP repair than for open mesh repair. TEP repairs can be performed efficiently and without major complications, even when the learning curve is included. Presented at the Annual Meeting of the Society of American Gastrointestinal and Endoscopic Surgeons, March 2003, Los Angeles, CA, USA     

A simplified laparoscopic technique for mesh placement in ventral hernia repair

The use of a large synthetic mesh for laparoscopic repair of significant ventral abdominal wall defects may be accompanied by technical difficulties resulting from improper orientation and positioning of the mesh over the defect. We suggest a technique based on initial fixation of the mesh center to the central point of the defect, and subsequent centrifugal attachment of the mesh to the abdominal wall. This technique is advantageous because it leads to precise orientation and positioning of the synthetic patch and to significant reduction of the time needed for its reinforcement over and around the defect. Received: 25 September 1998/Accepted: 27 November 1998     

A cost and outcome comparison between laparoscopic and Lichtenstein hernia operations in a day-case unit

Background: Laparoscopic hernia repair has often been criticized for its high costs. Methods: To compare the costs of laparoscopic and open hernia repair, 40 patients were randomized for either transabdominal laparoscopic or Lichtenstein mesh repair (under local anesthesia) in a day-case surgery unit. Results: Median operative times for the laparoscopic and open groups were 62 and 65 min, respectively. Postoperative pain was comparable for the two groups. The period before return to normal life was 14 days in the laparoscopic group and 21 days in the open group. The hospital costs were 2051 FIM ($1 US = 4.6 FIM) higher in the laparoscopic group, but the total costs for employed patients (including expenses due to lost work days) were lower. Conclusion: Although the Lichtenstein operation is cheaper for the hospital, the total costs for working patients are lower with the laparoscopic technique, when the cost of lost work days is factored into overall expense. Received: 5 May 1997/Accepted: 28 October 1997     

Laparoscopic vs open inguinal hernia repair

Background: The role of laparoscopic inguinal hernia repair is controversial. The aim of this study was to find out whether it is justified to switch from the predominantly modified Bassini repair which the authors had been using to laparoscopic repair. Methods: Randomized controlled trial in 120 eligible patients admitted for elective hernia repair in a university hospital. Results: Sixty patients underwent laparoscopic transabdominal preperitoneal mesh repair; the other 60 patients had an open repair, mostly with the modified Bassini technique. Operative time for laparoscopic repair was significantly longer, mean (s.d.) 95 (28) min vs 67 (27) min (p < 0.001). The mean analogue pain score during the first 24 h after surgery was 36.2 (20.2) in the laparoscopic group and 49.3 (24.9) in the open group (p= 0.006). The requirement for narcotic injections and postoperative disability in walking 10 m and getting out of bed were also significantly less following laparoscopic repair. The postoperative hospital stay was not significantly different, mean 2.6 (1.2) days for laparoscopic repair and 3.0 (1.5) days for open repair (p= 0.1). Patients were able to perform light activities without pain or discomfort sooner after laparoscopic repair, median interquartile range 8 (5–14) days vs 14 (8–19) days (p= 0.013). Patients also resumed heavy activities sooner, but not significantly, after laparoscopic repair, median 28 (17–60) days vs 35 (20–56) days (p= 0.25). The return to work was not significantly different, median 14 (8–25) days after laparoscopic repair and 15 (11–21) days after open repair (p= 0.14). After a mean follow-up of 32 months one patient developed a recurrent hernia 3 months after a laparoscopic repair. Laparoscopic repair was more costly than open repair by approximately $400. Conclusions. Laparoscopic inguinal hernia repair was associated with less early postoperative pain and disability and earlier return to full activities than open repair, but there were no benefits regarding postoperative hospital stay and return to work; laparoscopic repair was also more costly. Received: 23 May 1997/Accepted: 1 August 1997     

重要作用(附66例报道)腹膜前间隙在腹腔镜TAPP及TEP疝修补术中的

目的探讨腹腔镜经腹腹膜前(TAPP)和全腹膜外(TEP)疝修补术中腹膜前间隙的重要性。方法回顾性分析2008年1月至2011年4月期间笔者所在医院实施腹腔镜腹股沟疝修补术66例(78侧)患者的临床资料。结果本组行TAPP疝修补术16例(20侧),TEP疝修补术50例(58侧)。3例TEP疝修补术中转行TAPP疝修补术。单侧手术时间(86.92±36.38)min,术中出血(6.08±3.43)ml。术后并发症发生率为16.7%(11/66),其中术后浆液肿3例,修补区暂时性神经感觉异常3例,阴囊气肿2例,尿潴留2例,肠梗阻1例。复发2例。术后住院时间(4.52±0.99)d。出院后(10.32±1.86)d恢复日常活动和工作。66例均获随访,随访时间(18.56±1.96)个月(1～38个月),未观察到补片感染、慢性疼痛、睾丸萎缩等并发症。结论熟悉和掌握腹腔镜下腹膜前间隙及其重要结构,是避免腹腔镜腹股沟疝修补术术中及术后并发症发生的关键。     

Open or laparoscopic preperitoneal mesh repair for recurrent inguinal hernia?

Background: Giant prosthetic reinforcement of the visceral sac (GPRVS), an open preperitoneal mesh repair, is a very effective groin hernia repair. Laparoscopic transabdominal preperitoneal repair (TAPP), based on the same principle, is expected to combine low recurrence rates with minimal postoperation morbidity. Methods: Seventy-nine patients with 93 recurrent and 15 concomitant primary inguinal hernias were randomized between GPRVS (37 patients) and TAPP (42 patients). Operating time, complications, pain, analgesia use, disability period, and recurrences were recorded. Results: Mean operating time was 56 min with GPRVS versus 79 min with TAPP (p < 0.001). Most complications were minor, except for a pulmonary embolus and an ileus, both after GPRVS. Patients experienced less pain after a laparoscopic repair. Average disability period was 23 days with GPRVS versus 13 days with TAPP (p= 0.03) for work, and 29 versus 21 days, respectively (p= 0.07) for physical activities. Recurrence rates at a mean follow-up of 34 months were 1 in 52 (1.9%) for GPRVS versus 7 in 56 (12.5%) for TAPP (p= 0.04). Hospital costs in U.S. dollars were comparable, with GPRVS at $1,150 and TAPP at $1,179. Conclusions: Laparoscopic repair of recurrent inguinal hernia has a lower morbidity than GPRVS. However, laparoscopic repair is a difficult operation, and the potential technical failure rate is higher. With regard to recurrence rates, the open preperitoneal prosthetic mesh repair remains the best repair. Received: 14 April 1998/Accepted: 28 May 1998     

Needlescopic extraperitoneal repair of inguinal hernias

Laparoscopic inguinal herniorrhaphy has traditionally been performed using one 5-mm and two 11-mm trocars. In this report, we evaluate the feasibility of the preperitoneal repair of inguinal hernias using the needlescopic method (2-mm ports) and describe the technique used in this repair. A total of 11 inguinal hernias were treated with needlescopic extraperitoneal repair. There were five direct and six indirect hernias. One patient had a bilateral hernia. The average operative time was 54 min. One patient was converted to the standard laparoscopic extraperitoneal method. All patients were discharged a few hours after the procedure. They were able to resume activity within a few days and required only minimal analgesic intake. Follow-up ranged from 1 to 6 months. All patients were followed up by one of the surgeons at 1, 3, and 6 weeks, and then at 6 months. No complications were encountered. There have been no recurrences to date. Overall, needlescopic extraperitoneal repair of inguinal hernias is a feasible procedure in male patients seeking better cosmetic results than can be achieved with standard laparoscopic extraperitoneal repair. This procedure is technically more demanding. The operative time is longer. The cosmetic aspect is the only advantage of this technique. Received: 22 July 1998/Accepted: 13 October 1998     

A murine model of laparoscopic-assisted intervention

Background: In order to better investigate the effects of laparoscopic surgery, it is necessary to establish reliable, reproducible, and economical animal models of laparoscopic intervention. Here we describe a mouse model of laparoscopic-assisted colon resection. Methods: After successful induction of anesthesia the mouse is placed in Trendelenburg position and the peritoneal cavity is insufflated with carbon dioxide gas through an angiocatheter placed in the right upper quadrant. A 4-mm rigid scope with camera attachment is then inserted through a midline port created just caudal to the xiphoid. A second port is then created in the right lower quadrant to allow introduction of laparoscopic forceps into the peritoneal cavity. The cecum, which extends 1.5 cm beyond the ileocecal valve, is grasped with forceps and exteriorized through the operative port. Extracorporeally, the cecum is ligated and resected before the cecal stump is returned to the peritoneal cavity. The abdominal wall defects are then stapled closed. Results: This simple model can be mastered by individuals with very limited surgical experience. This laparoscopic model has been used successfully in our laboratory in a number of experiments with an intraoperative complication rate of 3.2% (3/94), which was similar to the open surgery group rate of 2.1% (2/95, p= 0.99 by chi square). We observed no postoperative leaks in either group. The only postoperative death occurred in the open resection group due to dehiscence of the laparotomy wound. Conclusions: We propose that this model may be useful for comparing the effects of open to laparoscopic surgery. Received: 19 June 1996/Accepted: 2 November 1996     

Laparoscopic approach to incarcerated inguinal hernia

The safety and effectiveness of laparoscopic treatment for incarcerated inguinal hernia have not been clarified. Six patients who underwent laparoscopic reduction and repair of incarcerated inguinal hernias were reviewed retrospectively. All operations were initiated within 1 h after establishment of the diagnosis. Laparoscopically, the incarcerated small-bowel segments could be easily returned to the abdominal cavity by a combination of pulling them with Babcock forceps while pushing back the bowels from outside the abdominal wall. The hernial portals were not cut in three patients, while they were dissected in the other three. All incarcerated bowels were congested and red immediately after reduction; however, their color returned to normal during hernia repair and unnecessary bowel resection was therefore avoided. The mean operation time was 88 min. Although one patient underwent laparotomy because of the suspicion of necrosis of the incarcerated inguinal hernia, which was finally found to be due to postoperative paralytic ileus, the postoperative courses of the remaining five were uneventful. Laparoscopic reduction and repair of incarcerated inguinal hernia was useful, and unnecessary bowel resection could be avoided. Received: 9 February 1996/Accepted: 20 May 1996     

In vivo study of meshes implanted over the inguinal ring and external iliac vessels in uncastrated pigs

Background: The effects of placing a prosthesis directly on the internal inguinal ring and external iliac vessels in inguinal hernia repair are unknown. We compared tissue responses to five prostheses implanted in this position in uncastrated male pigs. Methods: Three types of polypropylene and two types of expanded polytetrafluoroethylene (ePTFE) mesh were implanted in 20 pigs (n= 8 for each prosthesis type). Specimens of the implants and surrounding tissue were obtained 30 and 90 days after implantation and assessed histologically. Results: The polypropylene implants had more adhesions, more surface area covered by adhesions, and more tenacious adhesions than did the ePTFE implants. Perivascular cuffing was observed in eight polypropylene and one ePTFE specimen; ossification, necrosis, and testicular venous congestion were seen in polypropylene specimens. Conclusions: Abnormal healing processes after implantation of polypropylene mesh may increase complications of the transabdominal preperitoneal and total extraperitoneal approaches in laparoscopic inguinal hernia repair, whereas the minimal response to ePTFE meshes may make them safer for use in the preperitoneal space. Received: 2 April 1997/Accepted: 8 August 1997