Laparoscopic hernioplasty: significant complications (see comments)

摘要

BACKGROUND: The aim of this study was to determine the incidence and causes of serious complications after laparoscopic hernioplasty. Complications observed after laparoscopic hernia repair performed by a single surgeon specializing in the technique were analyzed. METHOD: A retrospective review of patients who underwent a laparoscopic hernioplasty, either transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP), was performed by the author between July 1991 and August 1997. RESULTS: In 1,087 patients, 1,423 hernias had been repaired by the TAPP or TEP approach. These were followed 1 month to 6 years. In patients followed at least 6 months with a median follow-up of 42 months, six repairs recurred (0.4%), and all underwent a remedial operation. Significant complications occurred in 29 patients (2.7%). Three of four intraoperative complications were in the surgeon's first 100 cases and consisted of bleeding from a trocar and injury to the bowel. Significant postoperation complications included pain in 12 patients: re-exploration required in 4, trocar hernia in 6, small bowel obstruction in 1, and hydrocele requiring surgery in 6. The incidence of complications in the first 3 years was 5.6% compared with 0.5% in the last 3 years, and 90% of complications developed in the first 50% of patients. CONCLUSIONS: This study demonstrated that the incidence of significant complications after laparoscopic hernioplasty could be substantially reduced by experience to less than 1%. The risk of complications after a totally extraperitoneal approach may be less than that of a transabdominal approach, but a randomized study is needed to confirm this supposition.