title: Feasibility of incremental laparoscopic inguinal hernia repair development in China: an 11-year experience.
abstract: BACKGROUND
  Our objective was to investigate the feasibility of laparoscopic inguinal hernia repair during its developmental phases in China.
  
  
  METHODS
  The clinical data of 2,056 patients (2,473 hernias) who underwent laparoscopic inguinal hernia repair at Shanghai Minimally Invasive Surgery Center between January 2001 and December 2011 were analyzed retrospectively. The operation priority was used to divide the patients into 7 groups for analysis of the learning curve.
  
  
  RESULTS
  There were 1,005 transabdominal preperitoneal patch plastic repairs (TAPP), 1,458 total extraperitoneal repairs (TEP), and 10 intraperitoneal onlay mesh repairs performed on 874, 1,175, and 7 patients, respectively. Median follow-up period was 60 months. The operation time and postoperative hospital stay for TEP were considerably shorter than those for TAPP. The complication rate for TEP, especially seroma, was considerably lower. Transabdominal preperitoneal patch plastic repair was performed in 81.4% of the recurrent inguinal hernias. Seven patients underwent unilateral intraperitoneal onlay mesh repair and 3 others underwent unilateral intraperitoneal onlay mesh repair and TAPP on the opposite. Most of patients with grade I and II hernias underwent TEP. The learning curve has demonstrated that more obstacles occurred in the earlier phase of the laparoscopic inguinal hernia repair training, supported by findings such as fewer cases performed annually, longer operation time, and higher incidence of complications and recurrence. These findings have improved as experience is accumulated through more operations. In addition, the ratios of TEP to TAPP and mesh nonfixation to fixation also evolved throughout the course of the study.
  
  
  CONCLUSIONS
  Laparoscopic inguinal hernia repair is a feasible technique that can be popularized in China.
authors: Department of Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Shanghai Minimally Invasive Surgery Center, Shanghai, China.
authors: Bo
authors: B
authors: Feng
authors: Zi-Rui
authors: ZR
authors: He
authors: Jian-Wen
authors: JW
authors: Li
authors: Tian-Long
authors: TL
authors: Ling
authors: Yun
authors: Y
authors: Zhang
authors: Xin
authors: X
authors: Chen
authors: Ai-Guo
authors: AG
authors: Lu
authors: Ming-Liang
authors: ML
authors: Wang
authors: Min-Hua
authors: MH
authors: Zheng
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D002681:China; D005240:Feasibility Studies; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome