A Walk along the Learning Curve of Totally Extra-Peritoneal (TEP) Repair of Inguinal Hernia
- *Corresponding Author:
- Arshad M.Malik
Associate Professor Surgery
College Of Medicine, Al-Qassim University
Qassim. Saudi Arabia
E-mail: [email protected]
Received date: March 22, 2012; Accepted date: April 18, 2012; Published date: April 20, 2012
Citation: Malik AM, Hussain Talpur KA, Soomro AG, Qureshi JN (2012) A Walk along the Learning Curve of Totally Extra-Peritoneal (TEP) Repair of Inguinal Hernia. Surgery Curr Res 2:116. doi:10.4172/2161-1076.1000116
Copyright: © 2012 Malik AM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Objectives/Background: Laparoscopic repair of inguinal hernia is a recent advancement gaining global popularity. It supposedly has a very steep learning curve due to various reasons. This study highlights an initial experience with totally extra-peritoneal repair of inguinal hernias with respect to difficulties, the learning curve, and outcome of this experience.
Methods: It’s a prospective descriptive analysis of first 78 consecutive TEP repairs of inguinal hernias performed in 67 patients in a teaching hospital as well as private hospitals during one and a half year. Patients less than 15 years, morbidly obese, old unfit patients and patients with previous history of lower abdominal surgery, recurrent hernias, complicated and complete scrotal hernias were excluded. All the patients were explained the new technique and were informed of the likely complications and all the known benefits. Those who gave consent were registered as study subjects. Variables studied included demographics, difficulties/complications during surgery, early post-operative complications, chronic pain and recurrence of hernia. A detailed pro forma was duly filled in by one of the authors and attached with history chart of every patient. The patients were reviewed after 15 days and then every three months for a period of one year. The data collected was then statistically analyzed on SPSS version 16.
Results: This study took one and a half years to complete from Jan 2009 to Jun 2010 during which we operated 67 patients with 78 primary inguinal hernias with a mean age of 40.27, Std 9.724 and a range of 38(20-58) years. All the patients were males with 56 (83.58%) unilateral and 11 (16.41%) bilateral inguinal hernia. The mean operative time of the initial 30 cases was reduced by 50% in the last cases. A number of early post-operative complications occurred during the same hospitalization. Results of three years of follow up are quite promising and encouraging.
Conclusion: TEP is a safe and reliable method of inguinal hernia repair. Initial problems and fear due to a totally different anatomy soon overcome by repeated attempts at repair by this technique and sticking to the rules laid down by experts in this field.