Inguinal hernia repair in a community hospital setting--have attitudes changed because of laparoscopy? A review of a general surgeon's experience over the last 5 years.
OBJECTIVE
The laparoscopic transabdominal preperitoneal (TAPP) approach for inguinal hernia repair is well documented in numerous studies as an excellent choice when performed by an experienced surgeon. In this report we wish to evaluate our experience of TAPP laparoscopic inguinal repair performed in a Community Hospital over the last 5 years, focusing on the feasibility of the technique and the incidence of complications when performed by general surgeons in this setting. We also wish to report and discuss how our attitudes concerning inguinal hernia repair have changed since we adopted the laparoscopic approach.


METHODS
Between January 2003 and January 2008 a total of 193 patients, at "Civil Hospital" in Vittorio Veneto (TV), underwent TAPP laparoscopic inguinal hernia repair. The total hernias repaired were 362.


RESULTS
The overall mean operative time was 45.58 min. (+/-15.2 min). All the procedures were performed in day surgery. There were no conversions to open repair or deaths in our series. We had 2 cases of small bowel occlusion and 5 relapsing hernias (1.3%), which we preferred to treat with an anterior approach. The mean follow-up was 30.4 (+/-5.6; range: 1 to 60 mo) months. No patients reported severe pain at 10 days, 7.2% (14 cases) reported mild pain at 3 months. There were no reports of night pain at 30 days. Approximately 90% of the patients had a return to physical-work capacity within 7 days, the remainder within 14 days. All patients were completely satisfied at 3 months.


CONCLUSIONS
The analysis of the short-term postoperative outcomes of our experience enabled us to conclude that in the proper setting TAPP is feasible, effective, safe, and beneficial for patients and should be a routine part of any surgical practice providing adequate training has been undertaken and proper preparation observed.
Agresta
Ferdinando
F
Department of General Surgery, Ospedale Civile, Vittorio Veneto (TV), Italy. fagresta@libero.it
Mazzarolo
Giorgio
G
Bedin
Natalino
N
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult