The Learning Curve for Totally Extraperitoneal (TEP) Repair in Inguinal Hernia

Lee, Jung Seob; Kim, Il Dong; Kim, Ki Ho; Shin, Dong Woo; Suh, Byung Sun; Kim, Sang Wook; Lim, Hye In; Park, Jin Soo

Abstract

PURPOSE
Laparoscopic totally extraperitoneal (TEP) repair has been increasingly used for the treatment of inguinal hernias. This procedure is a very difficult technically and it requires a great deal of experience. However, there are only few studies on the learning curve (LC) of this procedure in the Korea literature. The aim of this study is to determine the number of case that are needed to overcome the learning curve of TEP hernia repairs and to document the surgical and clinical differences before and after overcoming the LC.
METHODS
This study retrospectively reviewed 96 TEP hernia repairs that were performed by a single surgeon. The time required to overcome the LC was determined by examining the operation time. The preoperative and postoperative clinical data, such as incidental intraoperative findings, the rate of operative morbidity, the rate of conversion to an open procedure and the length of the postoperative hospital stay, were compared between the before and after groups with overcoming the LC.
RESULTS
The 40th case was determined to be the transition point of overcoming the LC according to the operation time. The time before overcoming the LC averaged 73.0 minutes compared to 55.6 minutes after overcoming the LC. The postoperative hospital stay and the conversion rate were all significant (p<0.05). However, the other postoperative outcomes did not show significant differences.
CONCLUSION
Based on the plateau of the operative time, this study shows that the downward slope of LC for TEP repair is at the 40th operation.