Laparoscopic total extraperitoneal inguinal hernia repair – the role of the expert in the learning curve

Aim: The aim of the study is to present our own experience in TEP, pointing out the advantages and disadvantages of the method and the role of the expert in the learning curve for TEP. Material and methods: Between 2000 and 2006 in the Minimally Invasive Centre 266 TEP procedures were performed in 243 patients (in 23 bilateral). There were 230 men and 13 women aged from 22 to 81 years old (mean 49). Expert’s help consisted of surgical course led by him, live operations in our centre and teleconferences. It allowed us to achieve skills in TEP operations much faster than in the routine way. Results: Hernias as found intraoperatively were indirect in 182, direct in 54, femoral in 4 and combined in 16 cases. The operative time ranged from 30 to 140 min (mean 54 min). Mean hospital stay was 1.3 days. There was 1 conversion in a patient with recurrent hernia after bilateral TAPP procedure. Postoperative complications included: haematoma and seroma requiring needle puncture in 12 (4.9%) cases, 1 (0.4%) scrotal haematoma requiring surgical intervention, 1 (0.4%) early recurrence due to incorrect mesh placement and 1 (0.4%) inguinal neuralgia. Conclusions: The introduction of a suitable model of training based on exact co-operation with the expert shortens the learning curve for TEP. Operation performed by an experienced team is a safe and effective method of hernia treatment with a small risk of complications. Preperitoneal dissection of the hernia sack gives the possibility of excellent visualization of all potential hernia openings and of proper mesh placement. Placement of the mesh without stapling reduces the risk of neuralgias in the inguinal region.