Our experience in totally extraperitoneal hernioplasty: next step after 20 cases still learning curve?

Abstract

Our experience in totally extraperitoneal hernioplasty : next step after 20 cases still learning curve? As we know from history: despite the success of TAPP, many surgeons still thought that entering the abdominal cavity was too invasive for an inguinal hernia repair, and so a twist on TAPP emerged. General surgeon Barry McKernan, MD, managed to create a space in the preperitoneum without entering the abdomen completely, and TEP was born. [1] Despite totally extraperitonealy hernioplasty (TEP) history from 1993 year, we still look at the results, talk about learning curve,operation time and others. In laparoscopic inguinal hernia surgery, TEP is the first choice inguinal hernia repair in Switzerland [2]. After successful first 21 clinical cases(2012–2015) in TEP, we sought and were hope for better results.We compare retrospectively last 27 TEP hernia repair until December 2017 with first cases. We was hope, that our learning curve wil be about 20 TEP hernioplasty and for next TEP repairs we show better results. We retrospectively analyzed two devided groups of our patients: I.21 patiens after TEP until May 2015 and II.27 patients from May 2015 until December 2017. But our analyzed data was not optimistic and show for us, that Op. time was not decrease , but even increase untill 100min.From 60 min. to 180 min.(I-98,33 min.) Complication rate similar 1/3,7% (I-1/4.8%) and no significaly different. Others as a lenght stay in hospital, pain, no recurrens is same. Sure, in II group we has one clinical case with very difficult unexplained dissection of retroinguinal posterior wall tissues and Op. time even was increase until 180 min., bilateral hernia 7 cases, right hernia cases after open surgery (appendectomy). It was real reasons for increasing of Op. time in II group. In conclusion is not easy to compare clinical cases with different patients in small analysed group. We agree, that TEP difficult technique in inguinal hernia repair. [...].