The clinical data of 2,056 patients (2,473
hernias) who underwent laparoscopic
inguinal hernia repair at Shanghai
Minimally Invasive Surgery Center between January 2001 and December 2011 were analyzed retrospectively. The operation priority was used to divide the patients into 7 groups for analysis of the learning curve.
RESULTS: There were 1,005 transabdominal preperitoneal patch
plastic repairs (
TAPP), 1,458 total extraperitoneal repairs (
TEP), and 10 intraperitoneal onlay mesh repairs performed on 874, 1,175, and 7 patients, respectively. Median follow-up period was 60 months. The operation time and postoperative
hospital stay for
TEP were considerably shorter than those for
TAPP. The complication rate for
TEP, especially
seroma, was considerably lower. Transabdominal preperitoneal patch
plastic repair was performed in 81.4% of the recurrent
inguinal hernias. Seven patients underwent unilateral intraperitoneal onlay mesh repair and 3 others underwent unilateral intraperitoneal onlay mesh repair and
TAPP on the opposite. Most of patients with grade I and II
hernias underwent
TEP. The learning curve has demonstrated that more obstacles occurred in the earlier phase of the laparoscopic
inguinal hernia repair training, supported by findings such as fewer cases performed annually, longer operation time, and higher incidence of complications and recurrence. These findings have improved as experience is accumulated through more operations. In addition, the ratios of
TEP to
TAPP and mesh nonfixation to fixation also evolved throughout the course of the study.
CONCLUSIONS: