Hernia (2009) 13:115–119 DOI 10.1007/s10029-008-0442-5 123 ORIGINAL ARTICLE Laparoscopic inguinal total extraperitoneal hernia repair under spinal anesthesia without mesh Wxation in 1,220 hernia repairs M. Ismail · P. Garg Received: 9 July 2008 / Accepted: 2 October 2008 / Published online: 13 November 2008  Springer-Verlag 2008 Abstract Background The need for general anesthesia and the cost and pain due to metal staples required for Wxing the mesh are the major reported disadvantages of laparoscopic total extraperitoneal (TEP) hernia repair. We studied the feasi- bility and results of TEP done under spinal anesthesia with non-Wxation of the mesh (SA-NF). This group was com- pared to TEP done under general anesthesia with non-Wxa- tion of the mesh (GA-NF) and repairs done under SA with Wxation of the mesh (SA-F). Methods A retrospective analysis was carried out in 675 patients (1,289 hernias) in whom TEP was performed. The recurrence rate, pain scores at 24 h and 1 week, hospital stay, days to resume normal activities, seroma formation, and urinary retention rates were noted. Results A total of 1,289 TEP repairs (675 patients) were analyzed, with 636 patients (1,220 hernias) in the SA-NF group, 16 patients (27 hernias) in the GA-NF group, and 23 patients (42 hernias) in the SA-F group. Follow up ranged from 13 to 45 months. The recurrence rates, conversion rates, and complications were similar in all three groups. The mean hospital stay, days to resume normal activities, and pain scores were signiWcantly higher in the mesh Wxa- tion (SA-F) group. Conclusions TEP, done under SA and without Wxation of the mesh, is safe, feasible, and associated with low recur- rence rates. Since this procedure does not have the disad- vantages usually attributed to TEP, it can be possibly recommended as a Wrst-line procedure, even for unilateral inguinal hernias. Further studies are needed to substantiate this. Keywords Hernia · Inguinal hernia · Laparoscopic surgery · Recurrence · Seroma Introduction Laparoscopic total extraperitoneal repair (TEP) of inguinal hernias is rapidly becoming an established procedure. Decreased post operative pain and lesser morbidity are the main advantages of TEP over open hernia repair [1–5]. Laparoscopic hernia repair is now recommended as the method of choice for bilateral and recurrent inguinal her- nias [6]. The disadvantages of TEP are the requirement of general anesthesia (GA), the need to Wx the mesh, seroma formation, and the diYcult learning curve. Fixation of the mesh with metal staples, apart from increasing the cost, may lead to new post operative groin pain [1, 7, 8], which can even become chronic in small percentage of patients [9]. This had led to various studies showing that non-Wxa- tion of the mesh is safe, cost-eVective, and lead to no increased risk of hernia recurrence compared to conven- tional open hernia repair [10–16]. The requirement of GA for TEP repair also had several disadvantages compared to regional anesthesia, such as signiWcant hemodynamic changes, delayed recovery, post operative nausea and vomiting, increased cost, and the inability to give anesthe- sia in high cardio-pulmonary risk patients. Several studies M. Ismail Department of General and Laparoscopic Surgery, Moulana Hospital, Perintalmanna, Kerala 679322, India P. Garg Department of General Surgery, MM Institute of Medical Sciences and Research, Mullana, Haryana 133203, India P. Garg (&) 1139, Sector-11, Panchkula, Haryana 134112, India e-mail: drgargpankaj@yahoo.com