Análisis de la bilateralidad como factor de riesgo de malos resultados durante la curva de aprendizaje en la hernioplastia inguinal endoscópica extraperitoneal (TEP).

Introduction and objectives: Bilateral inguinal hernioplasty by endoscopic totally extraperitoneal approach (TEP) seems to increase the probability of complications and early postoperative pain compared to unilateral endoscopic hernioplasty. In this work we also try to determine if bilaterality increases the risk of conversion and recurrence during the learning curve. Methods: Between January 2017 and February 2020, 140 patients underwent TEP surgery by 2 surgeons in a single Center, establishing 2 groups: learning curve (LC) and mastery of the technique (MT). Conversion, intraoperative and postoperative complications, chronic pain, and recurrence were retrospectively analyzed. Logistic regression was performed to assess the effect of bilaterality on the results obtained. Results: 211 procedures were performed (CA: 80; SD: 131). The mean follow-up was 26.7 months (11-70, SD 1.9). The LC group presented an increase in conversion (5 % vs 3.05 %, p = 0.41), postoperative complications (16.2 % vs 10.7 %, p = 0.11) and recurrence (12.8 % vs 0 %, p < 0.001) compared to the MT group. In the LC group, bilaterality associated a non-significant increase in conversion (9.7 % vs 0 %, p = 0.94), complications (29 % vs 25 %, p = 0.76) and recurrence (19.3 % vs 18.7 %, p = 0.96). All the cases of conversion and recurrence took place in the second operated hernia. Conclusions: During the learning curve, bilateral inguinal hernioplasty by TEP increases the risk of conversion and recurrence of the hernia operated on second, and it is advisable not to include bilateral hernias in the initial training period. Studies with a larger number of cases could reach statistical significance. [ABSTRACT FROM AUTHOR]