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J Korean Soc Endosc Laparosc Surg. 2010 Dec;13(2):134-138. Korean. Original Article.
Lee JS , Kim ID , Kim KH , Shin DW , Suh BS , Kim SW , Lim HI , Park JS .
Department of Surgery, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea.

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.

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