A single surgeon’s experience of 1000 consecutive transabdominal preperitoneal repair cases and measures to prevent recurrence

Abstract

PURPOSE: In laparoscopic transabdominal preperitoneal repair (TAPP), the use of a larger mesh has been shown to reduce the rate of recurrence of hernia. However, recurrence may still be observed occasionally, especially in procedures performed by inexperienced surgeons. The purpose of this study was to clarify the learning curve of TAPP and to establish a procedure that precluded the possibility of recurrence. MATERIALS AND METHODS: We analyzed the learning curve based on operative time, recurrence, and complication in a single surgeon’s experience of 1,000 consecutive TAPP. In addition, by examining cases showing recurrence, techniques necessary to prevent recurrence were clarified. RESULTS: The operative time stabilized after 60 cases and continued to reduce thereafter. Recurrence of nine hernias in eight patients within 1 year of surgery was observed up to the 482nd case. Recurrence or intraoperative complication was not confirmed since then. Recurrence after primary inguinal hernia repair presented as indirect hernia-type recurrence. The causes of recurrence were incomplete parietalization in indirect sliding hernia, insufficient dissection of the lateral dorsal side, and up-rolling mesh placement with the lateral dorsal side. CONCLUSION: Recurrence can be prevented by sufficiently dissecting the preperitoneal space on the lateral dorsal side and taking care to avoid up-rolling of the mesh while it is being placed.

Keywords

• groin hernia
• learning curve
• recurrence
• transabdominal preperitoneal repair