2003, Number 4
Learning curve in laparoscopic inguinal surgery How to overcome it?
López CJA, Guzmán CF, Martínez GA
Full text
Language: Spanish
References: 16
Page: 291-294
PDF size: 58.86 Kb.
ABSTRACT
Antecedents: Laparoscopic inguinal herniorrhaphy has undergone diverse stages, loosing prestige at the beginning due to the high rate of complications and recurrences. This occurred because the basic principle of laparoscopic approach was not followed, i.e., to imitate what had already been proven in open surgery, changing only the approach, which will yield all the known advantages. It was not until 1992 that inguinal repair was performed following the Stoppa technique with a laparoscopic approach. Since then, those groups starting to use this technique and complying with the requisites of the learning curve have reported similar results and, in some cases, even better ones than those obtained in open tension-free mesh inguinal repair.Objective: To analyze the difficulties encountered during the learning curve in laparoscopic inguinal herniorrhaphy.
Patients and methods: From February 1995 to August 2002, 38 surgeons were trained in two-month courses, performing a total of 1050 laparoscopic inguinal herniorrhaphies in 1000 patients. The learning curve was defined as the number of required surgeries to reach an adequate surgical time, a similar rate of complications and recurrences as that obtained with the open approach, and a deep knowledge of the anatomy of the posterior inguinal region.
Results: Thirty procedures were needed to consider that the learning curve had been overcome. Morbidity was of 8.5% and recurrences of 1.5%, which did not vary during the teaching process even in the presence of the tutors during the procedure. According to a recent survey, from the total of trained surgeons, only 10% are performing laparoscopic inguinal herniorrhaphies.
Conclusion: To justify a laparoscopic inguinal herniorrhaphy the following requisites must be fulfilled. Surgical time must be similar to that of the open surgery, morbidity and recurrences must be lower or the same as those obtained with traditional surgery, besides offering the already known advantages of laparoscopic surgery. To overcome the learning curve in laparoscopic inguinal herniorrhaphy, the surgeon must perform at least 30 procedures under tutorial assistance.
REFERENCES