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A single institution's experience with transperitoneal laparoscopic hernia repair
B J Leibl1, C G Schmedt, J Schwarz
1Department of General and Visceral Surgery, Marien-hospital, Stuttgart, Germany.
American Journal of Surgery
|June 30, 1998
Summary
The transabdominal preperitoneal patch (TAPP) technique is a reliable endoscopic method for hernia repair, suitable for routine use in unselected patients. This large-scale study demonstrates its effectiveness, especially for recurrent and bilateral hernias, with a low recurrence rate.
Area of Science:
- Minimally Invasive Surgery
- Surgical Oncology
- Gastrointestinal Surgery
Background:
- Limited data exists on endoscopic hernia surgery evaluations, often based on small series or few comparative studies.
- This study presents results from a large single-institution experience with the transabdominal preperitoneal patch (TAPP) technique.
- Focus is on the development and routine application of the TAPP method.
Purpose of the Study:
- To evaluate the efficacy and safety of the transabdominal preperitoneal patch (TAPP) technique in a large patient cohort.
- To assess the learning curve and complication rates associated with the TAPP procedure.
- To determine the recurrence rates and identify causes for recurrence after TAPP hernia repair.
Main Methods:
- 2,700 transabdominal preperitoneal patch (TAPP) procedures were performed between April 1993 and March 1997.
- Prospective data collection using a computed database for all cases.
- Follow-up was conducted with a median observation period of 20 months and an 86.5% follow-up rate.
Main Results:
- The majority of operations (83.8%) were for primary hernias, with 17.2% for recurrent hernias.
- A total recurrence rate of 1.03% was observed, with 0.97% after primary repair and 1.33% after recurrent repair.
- The most common cause of recurrence (39.3%) was a mesh size that was too small. The overall complication rate was 4.6%, decreasing from 7.8% to 2.8% over the study period.
Conclusions:
- The transabdominal preperitoneal patch (TAPP) technique is suitable as a standard method for unselected patients in a routine surgical setting.
- TAPP is particularly advantageous for recurrent, bilateral hernias, and in obese patients requiring a tension-free endoscopic repair.
- The study highlights the effectiveness of TAPP in managing a wide range of inguinal hernia cases.