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Selecting patients during the "learning curve" of endoscopic Totally Extraperitoneal (TEP) hernia repair.
- Source :
-
Hernia : the journal of hernias and abdominal wall surgery [Hernia] 2013 Dec; Vol. 17 (6), pp. 737-43. Date of Electronic Publication: 2012 Oct 27. - Publication Year :
- 2013
-
Abstract
- Background: Totally Extraperitoneal (TEP) hernia surgery is associated with little postoperative pain and a fast recovery, but is a technically demanding operative procedure. Apart from the surgeon's expertise, patient characteristics and hernia-related variations may also affect the operative time and outcome.<br />Methods: Patient-related factors predictive of perioperative complications, conversion to open anterior repair, and operative time were studied in a cohort of consecutive patients undergoing TEP hernia repair from 2005 to 2009.<br />Results: A total of 3,432 patients underwent TEP. The mean operative time was 26 min (SD ± 10.9), TEP was converted into an open anterior approach in 26 patients (0.8 %), and perioperative complications were observed in 55 (1.6 %) patients. Multivariable regression analysis showed that a history of abdominal surgery (OR 1.76, 95 per cent confidence interval 1.01-3.06; p = 0.05), and the presence of a scrotal (OR 5.31, 1.20-23.43; p = 0.03) or bilateral hernia (OR 2.25, 1.25-4.06; p = 0.01) were independent predictive factors of perioperative complications. Female gender (OR 5.30. 1.52-18.45; p = 0.01), a history of abdominal surgery (OR 3.96, 1.72- 9.12; p = 0.001), and the presence of a scrotal hernia (OR 34.84, 10.42-116.51, p < 0.001) were predictive factors for conversion. A BMI ≥ 25 (effect size (ES) 1.78, 95 % confidence interval 1.09-2.47; p < 0.001) and the presence of a scrotal (ES 5.81, 1.93-9.68; p = 0.003), indirect (ES 2.78, 2.05- 3.50, p < 0.001) or bilateral hernia (ES 10.19, 9.20-11.08; p < 0.001) were associated with a longer operative time.<br />Conclusion: Certain patient characteristics are, even in experienced TEP surgeons, associated with an increased risk of conversion and complications and a longer operative time. For the surgeon gaining experience with TEP, it seems advisable to select relatively young and slender male patients with a unilateral (non-scrotal) hernia and no previous abdominal surgery to enhance patient safety and 'surgeon comfort'.
- Subjects :
- Adult
Aged
Aged, 80 and over
Conversion to Open Surgery statistics & numerical data
Female
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Operative Time
Postoperative Complications epidemiology
Postoperative Complications etiology
Prospective Studies
Risk Factors
Treatment Outcome
Hernia, Inguinal surgery
Herniorrhaphy methods
Laparoscopy
Learning Curve
Patient Selection
Peritoneum surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1248-9204
- Volume :
- 17
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Hernia : the journal of hernias and abdominal wall surgery
- Publication Type :
- Academic Journal
- Accession number :
- 23104319
- Full Text :
- https://doi.org/10.1007/s10029-012-1006-2