Abstract
Background: A hernia surgery can be performed via the classical open technique, or laparoscopically. However, the later techniques viz. total extraperitoneal repair and transabdominal pre-peritoneal techniques are allied to a steep learning curve.
Aim and Objectives: In this study, we aim to define the learning curve associated with a TEP inguinal hernia repair.
Materials and Methods: We conducted a prospective study, of 125 patients with inguinal hernia posted for laparoscopic inguinal hernia repair by a total extra peritoneal technique, to assess the learning curve. Two surgeons: surgeon 1 (assessee, junior surgeon) and surgeon 2 (assessor, senior surgeon) were chosen. The learning curve was assessed for surgeon 1, who was a general laparoscopic surgeon, not performing laparoscopic hernia repair, while surgeon 2 was regularly performing laparoscopic hernia repairs. The study period was between January 2018 and January 2022. A direct comparison was made, based on operative time, peritoneal laceration, vascular injury, conversion rates, hospital stay and complications.
Results: Out of 125 patients, 50 patients were operated by the surgeon 1 and 75 were operated by surgeon 2. Mean operating time by surgeon 2 was 52 ± 4.5 minutes, and 66 ± 4.18 minutes for surgeon 1 with a p value of 0.0005. This was the only statistically significant variable, while surgical complications like peritoneal laceration, vascular injury or conversions to TAPP were statistically insignificant.
Conclusion: Surgeon 1 (Assessee) required to perform 10 TEP surgeries to overcome the learning curve. Therefore, surgeons with a prior experience in laparoscopic surgery needs a shorter learning curve as compared to a beginner in laparoscopic surgery, when it comes to laparoendoscopic groin hernia repair.

Key words: Total Extraperitoneal, Hernia, Repair, Learning curve, Difficult, experience