Selecting patients during the “learning curve” of endoscopic Totally Extraperitoneal (TEP) hernia repair

Schouten, N.; Elshof, J.W.; Simmermacher, R. K. J.; Dalen, Thijs van; Meer, S. G. A. de; Clevers, G. J.; Davids, P. H. P.; Verleisdonk, E. J. M. M.; Westers, Paul; Burgmans, J. P. J.

doi:10.1007/s10029-012-1006-2

Cited by 32 publications

(19 citation statements)

References 20 publications

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“…Irreducible hernias, hernias in patients with previous lower quadrant surgery, have been excluded in several early TEP series [3, 14]. Certain patient characteristics including female gender, higher BMI, previous history of abdominal surgery, and scrotal and bilateral hernias were also shown to be important for the high risk of conversion and intraoperative complications even for experienced surgeons.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

“…It could be possible to diminish the conversion rate in our study, if the strict inclusion criteria were used. Indeed, it is recommended to select relatively younger and slender male patients less than 60 years of age with unilateral, nonscrotal primary inguinal hernia during the learning period for TEP inguinal hernia repair [8, 14]. …”

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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“…In a previous report from our institution by Schouten, we showed that the intra-operative complication rate was 0.79 % in a cohort of 3432 patients with an inguinal hernia and the direct postoperative complication rate 0.35 %. While the mean age was 53 years treated by the TEP technique, elderly patients ([60 years) had a higher risk of perioperative complications [22,23]. Bay-Nielsen et al described that the risk of complications after herniorrhaphy was increased in patients older than 65 years (4.5 %) [12].…”

Section: Discussionmentioning

confidence: 97%

Totally extraperitoneal (TEP) endoscopic hernia repair in elderly patients

Voorbrood

Burgmans

Clevers

et al. 2015

Hernia

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“…The European Hernia Association reported that the surgeon's learning curve for videoendoscopic hernia surgery is within a range of 50-100 cases [19]. In a series of 90 cases, the learning threshold was 30, whereas in a 700-case series this number was reported to be 60 [20,21].…”

Section: Discussionmentioning

confidence: 99%

Video-endoscopic Tension-free Groin Hernia Repair via Total Extraperitoneal Approach

Doğan¹,

Gürleyik²

2020

Cureus

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IntroductionTension-free repair of groin hernias with synthetic material by video-endoscopic surgery is a widely accepted method that is performed by various approaches. We aim to present our results of video-endoscopic tension-free repair of groin hernias via the total extraperitoneal (TEP) approach. MethodsBetween September 2016 and December 2018, 124 patients with groin hernias underwent tension-free repair using prolene mesh by video-endoscopic surgery via the TEP approach. This is a retrospective analysis of 110 (88.7%) male and 14 (11.3%) female patients with a mean age of 48.1 years. Groin hernia types, locations of hernias, intraoperative and postoperative complications, results of the mean 24-month follow-up, and recurrence rate were reported. ResultsA total of 134 hernias were repaired in 124 patients who had 53 (42.7%) right, 61 (49.2%) left, and 10 (8.1%) bilateral groin hernias. The most common hernia type was an indirect inguinal hernia in 83/134 (62%) groin hernias. A total of 119 (88.8%) and 15 (11.2%) hernias were primary and recurrent, respectively. Seroma was detected in two (1.6%) patients in the early postoperative period. The mean duration of hospital stay was 1.4 (1-3) days. During the followup period, hernia recurrence was determined in three (2.4%) patients. Hernia recurrence was detected among patients who were operated on during the first half of the study. ConclusionTension-free repair of groin hernias by video-endoscopic technique via the TEP approach can be performed with very low complication and recurrence rates. The success of the TEP approach increases parallel to increasing surgical experience. The results of hernia repair via the TEP approach are highly satisfactory and encouraging, especially when attention is paid to proper patient selection during the learning curve period.

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Selecting patients during the “learning curve” of endoscopic Totally Extraperitoneal (TEP) hernia repair

Cited by 32 publications

References 20 publications

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

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

Totally extraperitoneal (TEP) endoscopic hernia repair in elderly patients

Video-endoscopic Tension-free Groin Hernia Repair via Total Extraperitoneal Approach

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