• J. Am. Coll. Surg. · Feb 2013

    Feasibility of incremental laparoscopic inguinal hernia repair development in China: an 11-year experience.

    • Bo Feng, Zi-Rui He, Jian-Wen Li, Tian-Long Ling, Yun Zhang, Xin Chen, Ai-Guo Lu, Ming-Liang Wang, and Min-Hua Zheng.
    • Department of Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Shanghai Minimally Invasive Surgery Center, Shanghai, China.
    • J. Am. Coll. Surg.. 2013 Feb 1;216(2):258-65.

    BackgroundOur objective was to investigate the feasibility of laparoscopic inguinal hernia repair during its developmental phases in China.Study DesignThe clinical data of 2,056 patients (2,473 hernias) who underwent laparoscopic inguinal hernia repair at Shanghai Minimally Invasive Surgery Center between January 2001 and December 2011 were analyzed retrospectively. The operation priority was used to divide the patients into 7 groups for analysis of the learning curve.ResultsThere were 1,005 transabdominal preperitoneal patch plastic repairs (TAPP), 1,458 total extraperitoneal repairs (TEP), and 10 intraperitoneal onlay mesh repairs performed on 874, 1,175, and 7 patients, respectively. Median follow-up period was 60 months. The operation time and postoperative hospital stay for TEP were considerably shorter than those for TAPP. The complication rate for TEP, especially seroma, was considerably lower. Transabdominal preperitoneal patch plastic repair was performed in 81.4% of the recurrent inguinal hernias. Seven patients underwent unilateral intraperitoneal onlay mesh repair and 3 others underwent unilateral intraperitoneal onlay mesh repair and TAPP on the opposite. Most of patients with grade I and II hernias underwent TEP. The learning curve has demonstrated that more obstacles occurred in the earlier phase of the laparoscopic inguinal hernia repair training, supported by findings such as fewer cases performed annually, longer operation time, and higher incidence of complications and recurrence. These findings have improved as experience is accumulated through more operations. In addition, the ratios of TEP to TAPP and mesh nonfixation to fixation also evolved throughout the course of the study.ConclusionsLaparoscopic inguinal hernia repair is a feasible technique that can be popularized in China.Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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