Laparoscopic transabdominal preperitoneal (TAPP) hernia repair: surgical phases and complications.
BACKGROUND
This study aimed to determine the nature of complications after transabdominal preperitoneal (TAPP) hernia repair, and to evaluate possible links to intraoperative factors in an effort to reduce the incidence of complications.


METHODS
The TAPP procedures for inguinal/femoral hernias performed between 1992 and 2004 at a single center were analyzed retrospectively. Complications were categorized according to severity and stage of the surgical procedure at which they occurred. Individual surgeon performances were examined to determine whether the rates of complications were related to surgeon experience.


RESULTS
A total of 1,973 TAPP procedures were reviewed, and 81% of the patients completed 5 years of follow-up evaluation. The 74 complications (3.7%) reported were categorized as follows: 33 major (1.7%) versus 41 minor (2.0%), 66 hernia-related (3.4%) versus 8 laparoscopy-related (0.5%) complications, and 12 recurrences (0.6%). Risk factors for complications included inguinoscrotal hernia (p < or = 0.001), dissection/reduction of the sac (p = 0.02), and surgeon experience (< 50 TAPP procedures; odds ratio, 7.1; 95% confidence interval, 4.2-11.9).


CONCLUSIONS
Accuracy in dissection/reduction of the sac improves the outcome of TAPP hernia repair. This effect is related to the experience of the surgeon. Experience performing more than 75 procedures is required for optimal results.
Lovisetto
F
F
Dipartimento di Scienze Chirurgiche, Rianimatorie-Riabilitative e dei Trapianti d'Organo, Facoltà di Medicina, University of Pavia, Pavia, Italy. fedelovi@yahoo.com
Zonta
S
S
Rota
E
E
Bottero
L
L
Faillace
G
G
Turra
G
G
Fantini
A
A
Longoni
M
M
D034861:Abdominal Wall / Q000601:surgery; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006550:Hernia, Femoral / Q000175:diagnosis / Q000601:surgery*; D006552:Hernia, Inguinal / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D010537:Peritoneum / Q000601:surgery; D011028:Pneumoperitoneum, Artificial; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology*; D011336:Probability; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016896:Treatment Outcome