World Journal of Laparoscopic Surgery

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VOLUME 17 , ISSUE 2 ( May-August, 2024 ) > List of Articles

Original Article

Negotiating Learning Curve in Enhanced-view Totally Extraperitoneal Repair (e-TEP) for Inguinal Hernia

Sunil Singh, Amarjot Singh, Rohit Srivastava, Vikas Singh, Priyanka Rai

Keywords : Laparoscopic, Laparoscopic hernia repair, Learning curves, Inguinal hernia

Citation Information : Singh S, Singh A, Srivastava R, Singh V, Rai P. Negotiating Learning Curve in Enhanced-view Totally Extraperitoneal Repair (e-TEP) for Inguinal Hernia. World J Lap Surg 2024; 17 (2):78-83.

DOI: 10.5005/jp-journals-10033-1612

License: CC BY-NC 4.0

Published Online: 18-04-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Introduction: Inguinal hernia repair is one of the most frequent surgeries performed by a general surgeon. The novel laparoscopic modification of totally extraperitoneal (TEP) hernioplasty to enhanced-view totally extraperitoneal (e-TEP) hernioplasty was pioneered by J Daes in 2012. The e-TEP technique ensures that the extraperitoneal space can be reached from almost anywhere in the anterior abdominal wall. The e-TEP approach can quickly and easily create an extraperitoneal space, provide a flexible port setup adaptable to many situations, ease the management of the distal sac, and improve tolerance of pneumoperitoneum. (e-TEP) is now gaining popularity because of the lesser learning curve (LC). The aim of this study was to see the LC for laparoscopic e-TEP repair for inguinal hernia. The primary objective of this study was to evaluate the mean operating time (OT) and secondary objectives were to assess the complications and the rate of early discharge. Methodology: A retrospective analysis of the medical records of 42 patients scheduled for laparoscopic e-TEP repair for inguinal hernia was done from July 2018 to Feb 2023 in Dr. RMLIMS Lucknow India, a government medical Institute. Patients with complete or incomplete unilateral inguinal hernia and recurrences were included, complicated hernia and bilateral hernia were excluded from this study. Standard e-TEP access was created as described by Jorge D. All the procedures were carried out by a single surgeon under general anesthesia. Besides, demographic data such as age, sex, body mass index (BMI), umbilicus to pubic symphysis distance, Direct/indirect inguinal hernia, complete/incomplete hernia, and size of defect were collected. In addition to that OT, postoperative duration of hospital stay, and complications such as bleeding and peritoneal rents were also collected. The surgeon's competency was evaluated by the OT [moving average curve and LC by cumulative sum (CUSUM)] frequency of complications and length of hospital stay. Results: Reducing trend of the mean OT with the passage of phases I–III was observed. The curve is steep and first increases rapidly with a small plateau phase followed by a decreasing phase. Phase I had patients from 1 to 13, phase II had patients from 14 to 28, and phase III had patients from 29 to 42. Conclusion: In this study, the LC for e-TEP using CUSUM analysis for operative time and surgical failure was evaluated. For an experienced laparoscopic surgeon, we estimated that a minimum of 42 cases were needed to overcome the LC for e-TEP with an operative time of 78.71 ± 10.02 minutes.

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