The aim of this study was to determine the incidence and causes of serious complications after laparoscopic hernioplasty. Complications observed after laparoscopic hernia repair performed by a single surgeon specializing in the technique were analyzed.A retrospective review of patients who underwent a laparoscopic hernioplasty, either transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP), was performed by the author between July 1991 and August 1997.In 1,087 patients, 1,423 hernias had been repaired by the TAPP or TEP approach. These were followed 1 month to 6 years. In patients followed at least 6 months with a median follow-up of 42 months, six repairs recurred (0.4%), and all underwent a remedial operation. Significant complications occurred in 29 patients (2.7%). Three of four intraoperative complications were in the surgeon's first 100 cases and consisted of bleeding from a trocar and injury to the bowel. Significant postoperation complications included pain in 12 patients: re-exploration required in 4, trocar hernia in 6, small bowel obstruction in 1, and hydrocele requiring surgery in 6. The incidence of complications in the first 3 years was 5.6% compared with 0.5% in the last 3 years, and 90% of complications developed in the first 50% of patients.This study demonstrated that the incidence of significant complications after laparoscopic hernioplasty could be substantially reduced by experience to less than 1%. The risk of complications after a totally extraperitoneal approach may be less than that of a transabdominal approach, but a randomized study is needed to confirm this supposition.