Laparoscopic totally extraperitoneal inguinal hernia repair: A personal experience and learning curve

Background : Even though laparoscopic hernia repair has been shown to be an efficient method with the benefits of minimally invasive surgery, it is poorly accepted in general surgical practice.
Aims : To evaluate the safety, complications and recurrence rates of laparoscopic totally extraperitoneal (TEP) repair and reflect on the learning curve.
Setting : Single surgeon series from Princess Royal Hospital, Telford, United Kingdom.
Materials and Methods : Prospectively collected data of laparoscopic TEP repairs performed by a single surgeon (JDP) between January 2001 and February 2006 were analyzed. 134 patients in the age range of 19 to 86 years had laparoscopic TEP repair for 209 inguinal herniae. Herniae were classified according to the type and Nyhus grades. A 10 mm reusable and two 5 mm ports were placed in the midline subumbilically. A large 12 x 15 cm polypropylene mesh was used with a lateral fish tail slit around the cord structures. No mesh fixation was employed and the rectus sheath at the umbilical port was closed in only 27% of the patients. Operating times, intraoperative and postoperative complications were recorded. The majority of the patients stayed overnight in the hospital. Overall morbidity was 13% with no wound or mesh infections. Overall recurrence rate was 2.4% and recurrence rate for primary hernia repair was 1.85%. Follow-up period was 6 months to 66 months with a median of 24.5 months.
Conclusions : Laparoscopic TEP repair is a safe and efficient method of hernia repair with low morbidity but with a long learning curve.