Laparoscopic recurrent inguinal hernia repair during the learning curve: it can be done?

Trans-Abdominal Preperitoneal Patch (TAPP) repairs for Recurrent Hernia (RH) is a technically demanding procedure. It has to be performed only by surgeons with extensive experience in the laparoscopic approach. The purpose of this study is to evaluate the surgical safety and the efficacy of TAPP for RH performed in a tutoring program by surgeons in practice (SP).

All TAPP repairs for RH performed by the same surgical team have been included in the study. We have evaluated the results of three SP during their learning curve in a tutoring program. Then these results have been compared to those of a highly experienced laparoscopic surgeon (Benchmark).

A total of 530 TAPP repairs have been performed. Among these, 83 TAPP have been executed for RH, of which 43 by the Benchmark and 40 by the SP. When we have compared the outcomes of the Benchmark with those of SP, no significant difference has been observed about morbidity and recurrence while the operative time has been significantly longer for the SP. No intraoperative complications have occurred.

International guidelines urge that TAPP repair for RH has to be performed only by surgeons with extensive experience in the laparoscopic approach. The results of the present study demonstrate that TAPP for RH could be performed also by surgeons in training during a learning program.

We retain that an adequate tutoring program could lead a surgeon in practice to perform more complex hernia procedures without jeopardizing patient safety throughout the learning curve period.

Laparoscopy, Learning Curve, Recurrent Hernia.