M Soltés1, P Pazinka, J Radonak. 1. I. Chirurgická klinika LF UPJS a FNLP, Kosice, Slovenská republika. soltes.marek@yahoo.com
Abstract
AIMS: To analyse individual and institutional "learning curve" in laparoscopic transabdominal preperitoneal hernioplasty (TAPP) and to identify key moments in its introduction at surgical clinic. MATERIAL AND METHODS: Prospective unicentric clinical study. Longitudinal recording of information on age and sex of operated patients, type of hernia, size of implanted mesh, operative tactics and technique, complications and recurrence rate was performed. Obtained data was statistically analysed and tested repeatably, results interpreted with respect to need of modification of peri- and postoperative management. RESULTS: During the 10 year period 1058 laparoscopic hernioplasties TAPP were performed with overall recurrence rate 0.96% and zero conversion rate. Mean operating time was 60.15 +/- 24.27 minutes (30-175), 46.64 +/- 19.23 minutes in the last three years (last 541 patients). Thanks to prospective analysis of obtained results three important changes in the operative management were introduced: size of mesh enlarged from 7.5 x 15 cm to 10 x 15 cm, change of operating team and port sites set up and shift towards macroporous 3D-knitted light-weight polypropylene meshes. CONCLUSIONS: Crucial factor for successfull introduction of laparoscopic hernioplasty TAPP at surgical clinic is consistent follow-up which represents a source of valid information thus allowing to make important changes in patient management. TAPP represents demanding operation with significant individual and institutional learning curve. Operating time decreases significantly after 30 operations; with growing institutional experience recurrence rate decreases. Minimal size of implanted mesh should be 10 x 15 cm.
AIMS: To analyse individual and institutional "learning curve" in laparoscopic transabdominal preperitoneal hernioplasty (TAPP) and to identify key moments in its introduction at surgical clinic. MATERIAL AND METHODS: Prospective unicentric clinical study. Longitudinal recording of information on age and sex of operated patients, type of hernia, size of implanted mesh, operative tactics and technique, complications and recurrence rate was performed. Obtained data was statistically analysed and tested repeatably, results interpreted with respect to need of modification of peri- and postoperative management. RESULTS: During the 10 year period 1058 laparoscopic hernioplasties TAPP were performed with overall recurrence rate 0.96% and zero conversion rate. Mean operating time was 60.15 +/- 24.27 minutes (30-175), 46.64 +/- 19.23 minutes in the last three years (last 541 patients). Thanks to prospective analysis of obtained results three important changes in the operative management were introduced: size of mesh enlarged from 7.5 x 15 cm to 10 x 15 cm, change of operating team and port sites set up and shift towards macroporous 3D-knitted light-weight polypropylene meshes. CONCLUSIONS: Crucial factor for successfull introduction of laparoscopic hernioplasty TAPP at surgical clinic is consistent follow-up which represents a source of valid information thus allowing to make important changes in patient management. TAPP represents demanding operation with significant individual and institutional learning curve. Operating time decreases significantly after 30 operations; with growing institutional experience recurrence rate decreases. Minimal size of implanted mesh should be 10 x 15 cm.