Laparoscopic totally extraperitoneal inguinal hernia repair: A personalexperience and learning curve
2007
Background : Even though laparoscopic hernia repair has been shown to
be an efficient method with the benefits of minimally invasive surgery,
it is poorly accepted in general surgical practice. Aims : To
evaluate the safety, complications and recurrence rates of laparoscopic
totally extraperitoneal (TEP) repair and reflect on the learning curve.
Setting : Single surgeon series from Princess Royal Hospital,
Telford, United Kingdom. Materials and Methods : Prospectively
collected data of laparoscopic TEP repairs performed by a single
surgeon (JDP) between January 2001 and February 2006 were analyzed. 134
patients in the age range of 19 to 86 years had laparoscopic TEP repair
for 209 inguinal herniae. Herniae were classified according to the type
and Nyhus grades. A 10 mm reusable and two 5 mm ports were placed in
the midline subumbilically. A large 12 x 15 cm polypropylene mesh was
used with a lateral fish tail slit around the cord structures. No mesh
fixation was employed and the rectus sheath at the umbilical port was
closed in only 27% of the patients. Operating times, intraoperative and
postoperative complications were recorded. The majority of the patients
stayed overnight in the hospital. Overall morbidity was 13% with no
wound or mesh infections. Overall recurrence rate was 2.4% and
recurrence rate for primary hernia repair was 1.85%. Follow-up period
was 6 months to 66 months with a median of 24.5 months. Conclusions :
Laparoscopic TEP repair is a safe and efficient method of hernia repair
with low morbidity but with a long learning curve.
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