Abstract
Background
Total extraperitoneal (TEP) hernia repair has been shown to offer less pain, shorter postoperative hospital stay and earlier return to work when compared to open surgery. Our institution routinely performs TEP procedures for patients with primary or recurrent inguinal hernias. The aim of this study was to show that supervised senior residents can safely perform TEP repairs in a teaching setting.
Methods
All consecutive patients treated for inguinal hernias by laparoscopic approach from October 2008 to June 2012 were retrospectively analyzed from a prospective database.
Results
A total of 219 TEP repairs were performed on 171 patients: 123 unilateral and 48 bilateral. The mean patient age was 51.6 years with a standard deviation (SD) of ± 15.9. Supervised senior residents performed 171 (78 %) and staff surgeons 48 (22 %) TEP repairs, respectively. Thirty-day morbidity included cases of inguinal paresthesias (0.4 %, n = 1), umbilical hematomas (0.9 %, n = 2), superficial wound infections (0.9 %, n = 2), scrotal hematomas (2.7 %, n = 6), postoperative urinary retentions (2.7 %, n = 6), chronic pain syndromes (5 %, n = 11) and postoperative seromas (6.7 %, n = 14). Overall, complication rates were 18.7 % for staff surgeons and 19.3 % for residents (p = 0.83). For staff surgeons and residents, mean operative times for unilateral hernia repairs were 65 min (SD ± 18.9) and 77.6 min (SD ± 29.8) (p = 0.043), respectively, while mean operative times for bilateral repairs were 115 min (SD ± 40.1) and 103.6 (SD ± 25.9) (p = 0.05).
Conclusions
TEP repair is a safe procedure when performed by supervised senior surgical trainees. Teaching of TEP should be routinely included in general surgery residency programs.
Similar content being viewed by others
References
Zib M, Gani J (2002) Inguinal hernia repair: where to next? ANZ J Surg 72:573–579
Rutkow IM, Robbins AW (1993) Demographic, classificatory, and socioeconomic aspects of hernia repair in the United States. Surg Clin N Am 73:413–426
Kuhry E, van Veen RN, Langeveld HR et al (2007) Open or endoscopic total extraperitoneal inguinal hernia repair? A systematic review. Surg Endosc 21:161–166
Butler RE, Burke R, Schneider JJ et al (2007) The economic impact of laparoscopic inguinal hernia repair: results of a double-blinded, prospective, randomized trial. Surg Endosc 21:387–390
Bracale U, Melillo P, Pignata G et al (2012) Which is the best laparoscopic approach for inguinal hernia repair: TEP or TAPP? A systematic review of the literature with a network meta-analysis. Surg Endosc 26:3355–3366
Khoury N (1998) A randomized prospective controlled trial of laparoscopic extraperitoneal hernia repair and mesh-plug hernioplasty: a study of 315 cases. J Laparoendosc Adv Surg Tech Part A 8:367–372
Bringman S, Ramel S, Heikkinen TJ et al (2003) Tension-free inguinal hernia repair: TEP versus mesh-plug versus Lichtenstein: a prospective randomized controlled trial. Ann Surg 237:142–147
Liem MS, van Duyn EB, van der Graaf Y et al (2003) Recurrences after conventional anterior and laparoscopic inguinal hernia repair: a randomized comparison. Ann Surg 237:136–141
Wright D, Paterson C, Scott N et al (2002) Five-year follow-up of patients undergoing laparoscopic or open groin hernia repair: a randomized controlled trial. Ann Surg 235:333–337
Lal P, Kajla RK, Chander J et al (2003) Randomized controlled study of laparoscopic total extraperitoneal versus open Lichtenstein inguinal hernia repair. Surg Endosc 17:850–856
Memon MA, Cooper NJ, Memon B et al (2003) Meta-analysis of randomized clinical trials comparing open and laparoscopic inguinal hernia repair. Br J Surg 90:1479–1492
Medical Research Council Laparoscopic Groin Hernia Trial Group (2001) Cost-utility analysis of open versus laparoscopic groin hernia repair: results from a multicentre randomized clinical trial. Br J Surg 88:653–661
Tschuor C, Metzger J, Clavien PA et al (2015) Inguinal hernia repair in Switzerland. Hernia J Hernias Abdom Wall Surg 19:741–745
Aeberhard P, Klaiber C, Meyenberg A et al (1999) Prospective audit of laparoscopic totally extraperitoneal inguinal hernia repair: a multicenter study of the Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTC). Surg Endosc 13:1115–1120
Schouten N, Simmermacher RK, van Dalen T et al (2013) Is there an end of the “learning curve” of endoscopic totally extraperitoneal (TEP) hernia repair? Surg Endosc 27:789–794
Lau H, Patil NG, Yuen WK et al (2002) Learning curve for unilateral endoscopic totally extraperitoneal (TEP) inguinal hernioplasty. Surg Endosc 16:1724–1728
Zendejas B, Onkendi EO, Brahmbhatt RD et al (2011) Long-term outcomes of laparoscopic totally extraperitoneal inguinal hernia repairs performed by supervised surgical trainees. Am J Surg 201:379–383 (Discussion 383-374)
Cho A, Basson S, Tsang T (2013) Outcomes of a structured training programme for paediatric laparoscopic inguinal hernia repair. J Pediatr Surg 48:404–407
Schouten N, Elshof JW, Simmermacher RK et al (2012) Selecting patients during the “learning curve” of endoscopic totally extraperitoneal (TEP) hernia repair. Hernia J Hernias Abdom Wall Surg 17:737–743
Bittner R, Sauerland S, Schmedt CG (2005) Comparison of endoscopic techniques vs Shouldice and other open nonmesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Surg Endosc 19:605–615
Garg P, Rajagopal M, Varghese V et al (2009) Laparoscopic total extraperitoneal inguinal hernia repair with nonfixation of the mesh for 1,692 hernias. Surg Endosc 23:1241–1245
Winslow ER, Quasebarth M, Brunt LM (2004) Perioperative outcomes and complications of open vs laparoscopic extraperitoneal inguinal hernia repair in a mature surgical practice. Surg Endosc 18:221–227
Gutlic N, Rogmark P, Nordin P et al (2015) Impact of mesh fixation on chronic pain in total extraperitoneal inguinal hernia repair (TEP): A nationwide register-based study. Ann Surg 263:1199–1206
Koch CA, Greenlee SM, Larson DR et al (2006) Randomized prospective study of totally extraperitoneal inguinal hernia repair: fixation versus no fixation of mesh. JSLS J Soc Laparoendosc Surg Soc Laparoendosc Surg 10:457–460
Taylor C, Layani L, Liew V et al (2008) Laparoscopic inguinal hernia repair without mesh fixation, early results of a large randomised clinical trial. Surg Endosc 22:757–762
Amid PK, Hiatt JR (2007) New understanding of the causes and surgical treatment of postherniorrhaphy inguinodynia and orchalgia. J Am Coll Surg 205:381–385
Burgmans JP, Schouten N, Clevers GJ et al (2015) Pain after totally extraperitoneal (TEP) hernia repair might fade out within a year. Hernia J Hernias Abdom Wall Surg 19:579–585
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors (F. Garofalo, P. Mota-Moya, A. Munday and S. Romy) have no conflicts of interest or financial ties to disclose.
Human and animal rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Rights and permissions
About this article
Cite this article
Garofalo, F., Mota-Moya, P., Munday, A. et al. Total Extraperitoneal Hernia Repair: Residency Teaching Program and Outcome Evaluation. World J Surg 41, 100–105 (2017). https://doi.org/10.1007/s00268-016-3710-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-016-3710-z