The aim of the study was to evaluate the safety and efficacy of two techniques of laparoscopic hernia repair: the transabdominal preperitoneal technique (TAPP) and the intraperitoneal onlay mesh technique (IPOM). In May 1992 a prospective randomized trial was initiated to compare TAPP and IPOM. Until October 1994, 115 patients with 148 hernias took part in the trial (59 TAPP and 56 IPOM). The TAPP took significantly longer than did the IPOM. There were no intraoperative complications, conversions to open repair, or postoperative deaths in either group. There were 10 (16.9% of patients) postoperative complications in the TAPP group and 14 (25%) in the IPOM group. The difference was not statistically significant. Neuralgias occurred in 3 cases of TAPP and 11 cases of IPOM (p < 0.05), local hematoma in 6 cases of TAPP and 3 cases of IPOM (NS), and urinary retention in 1 case of TAPP and in no case of IPOM (NS). Recurrences occurred in no cases of TAPP and in 8 cases (11.1% of hernias) of IPOM (p < 0.01). The results of the present report suggest that the IPOM technique for laparoscopic hernia repair should be avoided, whereas TAPP appears to be an excellent technique with no early recurrences.
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