The evolution of minimally invasive inguinal hernia repairs

摘要

Abstract: Groin hernia repairs are one of the most common surgeries performed in the world. The first repairs dates back to ancient Egypt in which physicians reduced the hernia and applied heat to the hernia sac. This review article explores the evolution of inguinal hernia repairs. It begins with the history of open inguinal hernia repairs and the evolution of minimally invasive approaches from laparoscopic to robotic repairs. The article also provides a comprehensive review of inguinal hernia anatomy and the myopectineal orifice. Laparoscopic inguinal hernia repairs are the recommended approach by multiple international guidelines to bilateral and recurrent hernias. This article provides a review of the comparison between open Lichtenstein (OL) repairs with minimally invasive approaches such as the laparoscopic transabdominal preperitoneal (TAPP) repair, totally extraperitoneal (TEP) repair and robotic-assisted TAPP repairs. Overall, laparoscopic repairs are associated with reduced post-operative pain, faster return to work/activities, decreased rate of hematoma and wound infections while hernia recurrence are comparable with OL repairs. This article also explores the emergence of robotic-assisted repairs with data suggesting that robotic repairs are a promising approach for patients with complex hernias such as recurrent hernias, post-prostatectomy, and for obese patients. This article also discusses the current utilization of minimally invasive inguinal hernia repairs around the world and the financial implications.