The Clinical Effectiveness of a Teaching Course on the Use of Totally Extraperitoneal Approach for Inguinal Hernia Repairs

Abstract Background There is an increasing shift towards the use of laparoscopic techniques for repair of inguinal hernias, namely the transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) approaches. Previous work has reported shorter post-operative length of stay (LOS), better pain control and faster return to function with laparoscopic techniques. Hence, we designed and conducted a one-day training course on TEP repairs for senior minimally invasive surgeons. This study aims to assess the clinical effectiveness of the course in changing our unit’s clinical practice and characterise the associated post-operative outcomes. Methods This is a single-center retrospective cohort study of hernia repairs performed by six consultant minimally invasive surgeons. All adult patients who underwent inguinal hernia repairs at our hospital between April 2022 – April 2023 were included. The primary outcome measures are the approaches used for each operation and post-operative LOS. Secondary outcome measures were conversion to open, incidence of complications, re-admissions, and re-interventions. Results We performed 223 hernia repairs over a 12-month period, with 88 and 135 procedures before and after the intervention, respectively. The mean age of patients was 60.7 (15.2). While the number of open repairs increased by 43% from 67 to 96, the number of TEP procedures increased eight-fold from 4 to 33 (p 0.05). The number of TAP repairs decreased from 17 to 6 in the same time period. There were two conversions of TEP to open repairs. Post-operatively, the length of stay was lower for TEP than open repairs at 0.27 and 0.42 days, respectively (p 0.05). The incidence of hematoma/seroma was higher with open repairs (n = 7) than TEP repairs (n = 1). However, all were conservatively managed till resolution, with no re-interventions at follow-up. Conclusion The implementation of a teaching course tailored to the surgical expertise of laparoscopic surgeons can update and change local clinical practice, and attain the clinical outcomes reported in literature.