A 2.8-year prospective multicenter trial was conducted to evaluate the ePTFE peritoneal onlay laparoscopic inguinal hernioplasty. A total of 441 inguinal hernias were repaired in 351 patients (326 male; 25 female). Two hundred twenty-six of the hernias were direct, 185 indirect, 4 femoral, 26 pantaloon, 90 bilateral, and 92 recurrent. Standardized data collection forms were used and submitted for centralized data analysis. For the hernioplasty, Cooper's ligament was exposed and an 8 cm x 12 cm x 1 mm GORE-TEX Soft Tissue Patch was stapled circumferentially to Cooper's ligament and the endoabdominal fascia. Patients were followed at 1 week, 6 months, 1 year, and then annually. Three-month intervals were used as needed. There was a mean follow-up of 447 days, with 21% of the total repairs followed for more than 2 years and 56% for more than a year. The overall follow-up rate was 95.5%. The operative and postoperative complication rates were 0.45% and 8%, respectively. There were 17 recurrent hernias (3.8%). The range of experience among the investigators was 13 to 168 hernioplasties. With the completion of 25 cases per investigator, the recurrence rate fell to 0.39%. Postoperative analgesia averaged a 24-hr supply of medication; 12.2% of patients required no analgesia. Convalescence averaged 5.4 days, and return to work averaged 7.7 days. This multicenter trial demonstrates that the ePTFE laparoscopic peritoneal onlay inguinal hernioplasty is a safe and dependable repair, especially after the initial learning curve is surmounted.

The Toy-Smoot laparoscopic hernioplasty has been performed on 75 patients with a total of 83 hernioplasties over the past 20 months. Sixty-nine patients were male and six were female. The age range was 20 to 75 years with an average age of 51.5 years. Twelve of the patients had bilateral hernias repaired: 55 direct hernias, 16 indirect hernias, and 5 pantaloon hernias. Eleven of the repairs were for recurrent hernias. The procedure was performed under general anesthesia. The abdomen was insufflated with carbon dioxide, establishing the pneumoperitoneum. Three 11 mm trocars were inserted, the first via the umbilicus, into which the 0 degrees endoscope was inserted. Two additional trocars were inserted at the level of the umbilicus at the anterior axillary lines. The hernia sacs were left in situ. The medial umbilical ligament was dissected medially, so as to identify directly the pubic tubercle and the Cooper's ligament. An expanded PTFE soft tissue patch, 1 mm thick and 7.5 x 10 cm in size, was attached to the Nanticoke Endo-patch spreader and introduced via the contralateral trocar and positioned over the hernia defect. The Endopath EMS stapler was then used to secure the PTFE patch over the hernia defect. This required secure anatomical fixation to the transversalis fascia anteriorly and laterally, the pubic tubercle, and the posterior rectus sheath, medially, Cooper's ligament, posteromedially, and the endoabdominal fascia, posterolaterally. There were a total of seven different complications, one major, which was a bladder injury that required an open repair of the bladder and then an open, conventional hernioplasty.(ABSTRACT TRUNCATED AT 250 WORDS)

The Toy-Smoot laparoscopic hernioplasty was performed in 10 patients with excellent short-term results. This laparoscopic hernioplasty utilizes the principles of high ligation of the sac, a tension-free repair, and the advantages of an expanded PTFE patch over other prosthetic patch materials without groin dissection. The Toy-Smoot laparoscopic hernioplasty is a safe and effective repair of both direct and indirect inguinal hernias. The patients experience only minimal pain and return to full activity by the second postoperative day.