The impact of the surgeon's experience on the results of laparoscopic hernia repair

Background: The aim of this study was to evaluate our experience with the totally extraperitoneal (TEP) laparoscopic approach to hernia repair. Methods: We performed a prospective study of 1227 hernia repairs using the TEP technique over a 7-year period. The main outcome measurements were postoperative complications, conversion rate, learning curve effect, surgery time, hospital stay, return to work, and recurrence rate. Results: The mean operating time was > 60 min during the first 50 cases, but it fall to 32 min for the last 200 cases (p < 0.05). The conversion rate was 5.7% (56 patients); declining from 17% in the first 100 cases to 2.2%, for the final 500 cases (p < 0.01). There were 79 complications (6.4%) and 23 recurrences (2.3%); 42% of the complications and 61% of the recurrences appeared in the first 100 cases (p < 0.05). Conclusion: This study shows that postoperative complications, conversion rate, operating time, and recurrences are all substantially reduced as the surgeon's experience increases. Thus, once the learning curve is surpassed, TEP repair represents a good alternative to open techniques.