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

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Hasbahceci M., Basak F., Acar A., ALİMOĞLU O.

MINIMALLY INVASIVE SURGERY, vol.2014, 2014 (ESCI) identifier identifier

  • Publication Type: Article / Article
  • Volume: 2014
  • Publication Date: 2014
  • Doi Number: 10.1155/2014/528517
  • Journal Indexes: Emerging Sources Citation Index (ESCI), Scopus
  • Bezmialem Vakıf University Affiliated: Yes


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.