Laparoscopic hernia repair offers the potential for more rapid recovery in patients compared with standard anterior herniorrhaphy. Whether the procedure can be performed safely and effectively has yet to be determined. Long-term success will depend on the ability to adhere to the basic principles of traditional hernia repair, maintain low recurrence rates, and achieve rapid return of the patient to work. Inguinal anatomy as viewed through the laparoscope is unfamiliar to most surgeons. The potential for complications requiring laparotomy is increased with laparoscopic hernia repair and dissection in this region requires precise knowledge of the anatomic relationships. Photographic representations of cadaver dissections of the intra-abdominal inguinal region are displayed, and detailed descriptions applicable anatomic structures are presented. A laparoscopic approach for the repair of inguinal and femoral hernia is provided, based on sound comprehension of anatomic relationships.

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Anterior inguinal hernia repair is the second-most-commonly performed abdominal operation and has been associated with low morbidity and mortality rates. The principle of laparoscopy has been applied to this surgical problem in a series of 762 patients with 841 inguinal hernias. Four types of laparoscopic repairs were conducted: (1) high ligation of the indirect inguinal hernia sac and closure of the internal ring (87 patients with 89 hernias); (2) plug and patch of the internal ring (74 patients with 87 hernias); (3) transperitoneal suture repair of the transversalis fascia to the iliopubic tract or Cooper's ligament (28 patients with 30 hernias); and (4) placement of a large prosthesis over the myopectoneal orifice (563 patients with 635 hernias). These early results indicate that the overall complication rates were low, especially when a large prosthesis was used to reinforce the myopectoneal orifice. It is concluded that laparoscopic inguinal herniorrhaphy is a safe and effective procedure with which to manage this surgical problem.

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