TRANS-ABDOMINAL PRE-PERITONEAL LAPAROSCOPIC HERNIA REPAIR: A SINGLE CENTER EXPERIENCE (2024)

Introduction

Lichtenstein procedure and laparoscopic repair are the most recommended techniques for inguinal hernia repair. Laparoscopic techniques should be generally preferred for its benefits in faster recovery and lower rate of complications. Trans-abdominal preperitoneal (TAPP) laparoscopic repair is one of the common procedures. According to the European Hernia Society (EHS) the learning curve for laparoscopic technique of hernia repair is estimated at 50–100 procedures. There are several studies which resulted in lower numbers, mostly due to prior experience in laparoscopic techniques.

Method

We analyzed TAPP procedures for primary unilateral inguinal hernias between 2019 and 2023. In 2019 only the most senior residents performed their first TAPP surgeries, while by 2023, second year residents performed their first TAPP procedures.

Results

The residents had statistically significantly longer operating time, which is in line with the expected learning curve. They did not achieve enough surgeries to complete the learning curve. However, there was no statistically significant difference in perioperative complication rate. From 2019 to 2023 we raised the mini-invasive primary inguinal hernia repair from 24.7% to 52.57%. The percentage of TAPP surgeries performed by residents went from 16.13% to 36.95%, respectively.

Conclusion

While surgery in the Czech Republic has an excellent tradition and level of expertise, it is not a rule that all residents have enough experience leading the surgeries, especially laparoscopic, under the guidance of senior surgeons. Thus, local experience showing safety and feasibility of early experience as a leading surgeon in procedures like laparoscopic hernioplasty is valuable.