Long-term outcomes of laparoscopic totally extraperitoneal inguinal hernia repairs performed by supervised surgical trainees

Zendejas, Benjamin; Onkendi, Edwin; Brahmbhatt, Rushin D.; Lohse, Christine M.; Greenlee, Susan M.; Farley, David R.

doi:10.1016/j.amjsurg.2010.08.019

Cited by 36 publications

(20 citation statements)

References 8 publications

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“…Zendejas et al 56 found that the risk factors significantly associated with an increased risk of recurrence were direct hernias. In fact, the most common cause of recurrent inguinal OH is a direct hernia, not recognized at the time of initial repair.…”

Section: Discussionmentioning

confidence: 98%

See 1 more Smart Citation

Laparoscopic Versus Open Inguinal Hernia Repair in Pediatric Patients: A Systematic Review

Esposito¹,

Peter

Escolino³

et al. 2014

Journal of Laparoendoscopic & Advanced Surgical Techniques

130

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In this systematic review, it seems that LH is faster than OH for bilateral hernias, whereas there is no significant difference in terms of operative time for unilateral inguinal hernia repair. Recurrence rate is similar for both techniques. As for other complications such as wound infections, it is higher for OH compared with LH, especially in infants. A prospective comparative study is necessary on this topic to strongly support the results of our systematic review.

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Section: Discussionmentioning

confidence: 98%

“…In fact, the most common cause of recurrent inguinal OH is a direct hernia, not recognized at the time of initial repair. 56 Laparoscopy should eliminate this issue. As reported by Esposito et al 57 and Lima et al, 58 it is extremely easy in laparoscopy to identify a direct hernia.…”

Section: Discussionmentioning

confidence: 98%

Laparoscopic Versus Open Inguinal Hernia Repair in Pediatric Patients: A Systematic Review

Esposito¹,

Peter

Escolino³

et al. 2014

Journal of Laparoendoscopic & Advanced Surgical Techniques

130

View full text Add to dashboard Cite

show abstract

“…In a Cochrane review, it was suggested to perform at least between 30 and 100 operations as a critical threshold level to become an experienced surgeon [10, 11]. It is generally accepted that for a recurrence rate of less than 1%, more than 60 cases under supervision were recommended [2, 10, 12]. Lau et al reported that at least 80 operations were required for the mean operation time of less than 1 hour [3].…”

Section: Discussionmentioning

confidence: 99%

A New Proposal for Learning Curve of TEP Inguinal Hernia Repair: Ability to Complete Operation Endoscopically as a First Phase of Learning Curve

Hasbahçeci

Başak

Acar

et al. 2014

Minimally Invasive Surgery

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Background. The exact nature of learning curve of totally extraperitoneal inguinal hernia and the number required to master this technique remain controversial. Patients and Methods. We present a retrospective review of a single surgeon experience on patients who underwent totally extraperitoneal inguinal hernia repair. Results. There were 42 hernias (22 left- and 20 right-sided) in 39 patients with a mean age of 48.8 ± 15.1 years. Indirect, direct, and combined hernias were present in 18, 12, and 12 cases, respectively. The mean operative time was 55.1 ± 22.8 minutes. Peritoneal injury occurred in 9 cases (21.4%). Conversion to open surgery was necessitated in 7 cases (16.7%). After grouping of all patients into two groups as cases between 1–21 and 22–42, it was seen that the majority of peritoneal injuries (7 out of 9, 77.8%, P = 0.130) and all conversions (P = 0.001) occurred in the first 21 cases. Conclusions. Learning curve of totally extraperitoneal inguinal hernia repair can be divided into two consequent steps: immediate and late. At least 20 operations are required for gaining anatomical knowledge and surgical pitfalls based on the ability to perform this operation without conversion during immediate phase.

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“…Preparation in the preperitoneal space using the TEP technique is often depicted as being more complex, as anatomic landmarks are difficult to identify compared to the TAPP technique. This is reflected in the very large number of (approximately 200-300) interventions needed to achieve an acceptable threshold of complications and recurrence rates [4]. Although these numbers tend to be lower for the TAPP technique, both laparoscopic hernia repair methods have a longer learning curve than standard open repair [5,6].…”

Section: Introductionmentioning

confidence: 99%

TAPP or TEP? Population‐Based Analysis of Prospective Data on 4,552 Patients Undergoing Endoscopic Inguinal Hernia Repair

et al. 2012

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Background Whether total extraperitoneal inguinal hernia repair (TEP) is associated with worse outcomes than transabdominal preperitoneal inguinal hernia repair (TAPP) continues to be a matter of debate. The objective of this large cohort study is to compare outcomes between patients undergoing TEP or TAPP. Methods Based on prospective data of the Swiss association of laparoscopic and thoracoscopic surgery, all patients undergoing unilateral TEP or TAPP between 1995 and 2006 were included. The following outcomes were compared: conversion rates, intraoperative and postoperative complications, duration of operation. Results Data on 4,552 patients undergoing TEP (n = 3,457) and TAPP (n = 1,095) were collected prospectively. Average age and American Society of Anesthesiologists score were similar in the two groups. Patients undergoing TEP had a significantly higher rate of intraoperative complications (TEP 1.9 % vs. TAPP 0.9 %, p = 0.029) and surgical postoperative complications (TEP: 2.3 % vs. TAPP: 0.8 %, p = 0.003). The postoperative length of stay was longer for patients undergoing TAPP (2.9 vs. 2.3 days, p = 0.002), whereas the duration of the operation was longer for TEP (66.6 vs. 59.0 min, p \ 0.001) and the conversion rate was higher (TEP 1.0 % vs. TAPP 0.2 %, p = 0.011). Conclusions This study is one of the first populationbased analyses comparing TEP and TAPP in a prospective cohort of more than 4,500 patients. Intraoperative and surgical postoperative complications were significantly higher in patients undergoing TEP. TEP is also associated with longer operating times and higher conversion rates. Therefore, on a population-based level, the TAPP technique appears to be superior to the TEP repair in patients undergoing unilateral inguinal hernia repair.

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Long-term outcomes of laparoscopic totally extraperitoneal inguinal hernia repairs performed by supervised surgical trainees

Cited by 36 publications

References 8 publications

Laparoscopic Versus Open Inguinal Hernia Repair in Pediatric Patients: A Systematic Review

Laparoscopic Versus Open Inguinal Hernia Repair in Pediatric Patients: A Systematic Review

A New Proposal for Learning Curve of TEP Inguinal Hernia Repair: Ability to Complete Operation Endoscopically as a First Phase of Learning Curve

TAPP or TEP? Population‐Based Analysis of Prospective Data on 4,552 Patients Undergoing Endoscopic Inguinal Hernia Repair

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