Another Advantage of the Laparoscopic Approach

Originally, the National Institute for Clinical Excellence (NICE) recommended laparoscopic inguinal hernia repair for bilateral and recurrent hernias. However, on 23 September 2004, the NICE Technology Appraisal Guidance No. 18 stated that the laparoscopic approach was suitable for all inguinal hernias. In 1998, Wellwood et al.¹ published a randomised control trial comparing open tension-free mesh hernioplasty under local anaesthetic with transabdominal preperitoneal laparoscopic hernia repair under general anaesthesia. Patients' perception of health one month post-surgery and patient satisfaction were superior in the laparoscopic group and the convalescent period shorter. There will, of course, always be a place for open repair under local anaesthetic in patients who are unfit for general anaesthesia, or indeed patients who request this technique. However, the laparoscopic approach would seem to be superior and, in this particular case, there is no suggestion that the patient is unfit, or indeed requested a local anaesthetic repair. The fact that intraoperative swabs are not placed within any body cavity during a laparoscopic hernia repair means that this feared complication of a retained swab cannot occur. Is this yet another advantage of having a laparoscopic repair?