Plastía inguinal con abordaje laparoscópico TAPP vs TEP

Objective: To show the experience gained in laparoscopic surgery for the treatment of inguinal hernia, as well as the advantages and disadvantages of the TAPP and TEP techniques, comparing the initial period or learning curve stage with the consolidation stage in performing the technique. Setting: Minimally Invasive Training Center, Regional Hospital No. 1, IMSS, Tijuana, B.C. Design: Retrospective, transversal, descriptive, comparative study. Patients and methods: Patients subjected to inguinal hernia repair with laparoscopic approach, divided in two groups: Group A corresponds to the initial period or learning stage and group B to the consolidation stage. Analyzed variables were: age, gender, affected side, primary or recurrent hernia, type of hernia, morbidity (seroma, infection at the site of surgery), nervous injury, vascular injury, re-intervention or conversion to open technique, recurrence, and mortality. We compared morbidity and recurrence between both groups and between TAPP and TEP. Results: In group A, 1,000 patients were operated, 58% using TAPP and 42% with TEP, morbidity was of 8.5%, and recurrence of 1.5%. In group B, 184 patients were operated, 55.4% with TAPP and 44.5% with TEP, morbidity was of 3.7%, and recurrence of 0% until now. General morbidity χ2 = 7.38 (p 0.05). Conclusions: The surgeon’s experience does decrease the general morbidity in the laparoscopic approach for the treatment of inguinal hernia; there are no differences in either morbidity or recurrence between the TAPP and TEP approaching techniques. Resumen Objetivo: Mostrar la experiencia acumulada de la cirugia laparoscopica en el tratamiento de la hernia inguinal, asi como las ventajas y desventajas de la tecnica TAPP y TEP, comparando la etapa inicial o de curva de aprendizaje con la de consolidacion en la realizacion de la tecnica. Sede: Centro de Entrenamiento de Cirugia de Invasion Minima. HGR Num. 1 IMSS, Tijuana, B.C. Diseno: Estudio retrospectivo, transversal, descriptivo, comparativo. Material y metodos. Pacientes sometidos a plastia inguinal con abordaje laparoscopico, dividiendo en dos grupos: grupo A, correspondio a la etapa inicial o de curva de aprendizaje y grupo B, la etapa de consolidacion. Las variables analizadas fueron edad, genero, lado afectado, indicacion por hernia primaria o por recurrencia, tipo de hernia, morbilidad consistente en seroma, infeccion de sitio operatorio, lesion nerviosa, lesion vascular, reintervencion o conversion a tecnica abierta, recurrencia y mortalidad. Se comparo la morbilidad y recurrencia entre los dos grupos y entre TAPP y TEP. Resultados. En el grupo A se operaron 1,000 pacientes, 58% con tecnica TAPP y 42% con TEP, morbilidad de 8.5% y recurrencia de 1.5%. En el grupo B se operaron 184 pacientes, 55.4% con tecnica TAPP y 44.5% con TEP, morbilidad de 3.7% y recurrencia de 0% hasta el momento. Morbilidad general χ2=7.38 (p 0.05). Conclusiones. La experiencia del cirujano si disminuye la morbilidad general en el abordaje laparoscopico para el tratamiento de la hernia inguinal, no existiendo diferencia de morbilidad ni recurrencia entre las tecnicas de abordaje TAPP y TEP.