Implementation of a Laparoscopic Inguinal Hernia Repair Programme. Intraoperative Outcomes of a Four-Year Programme

Abstract Background Laparoscopic inguinal hernioplasty was first described in the early 1980s. However, according to the Spanish national database, only a small number of patients have actually undergone this technique. Material and Methods Descriptive and retrospective study of patients who underwent elective Totally Extraperitoneal (TEP) surgery between October 2019 and January 2024. Four surgeons with experience in laparoscopic surgery (1 also with advanced colorectal surgery experience, 2 also with advanced bariatric surgery experience) participated in training courses. Selection criteria were: bilateral hernias, recurrent hernias with previous anterior approach, ASA ≤ III, age ≥18 and primary unilateral hernias in athletic patients or patient's personal preference. Results 214 patients underwent surgery, 87.4% male, mean age 57.6 (SD 13.07, range: 20–88) years. The body mass index was 25,65 (SD 3.57, range: 17.3–42.1). Of these, 131 had bilateral hernias, and 83 unilateral (30 left side, 53 right side). 345 hernias were operated, 60 (17.39%) were recurrent. The mean operative time was 60 (SD 26.47, range: 20–180) minutes. There were 3 TEP to TAPP conversion and 7 to open approach (2 patients with recurrent hernias). Minor complications were: 1 inferior epigastric artery bleeding, the peritoneum was opened in 72 cases (closed with running sutures in 4 cases and with clips in 32 cases). There were 3 major complications: 1 preperitoneal haematoma reoperated within 12 hours, 1 intraoperative bladder perforation and 1 intraoperative external iliac vein injury. Conclusions TEP is feasible and safe, but there are many challenges, particularly in terms of a learning curve.