Proper training in laparoscopic hernia repair is necessary to minimize the rising recurrence rate in Japan

Abstract

INTRODUCTION: The Japan Society for Endoscopic Surgery reported that the recurrence rate for inguinal hernia repair in Japan was less than 1% in 2010. However, its 2012 survey found that the recurrence rate had increased to 4% for the transabdominal preperitoneal procedure and 5% for the totally extraperitoneal procedure. We held 14 hernia repair training courses from 2011 to 2016 with help from Covidien. This study aimed to determine the effect of this training on the recurrence rate. METHODS: Training was composed of a theoretical revision of inguinal anatomy, dry laboratory suturing, a video lecture, and practice on an animal model. We made inquiries about the length of each surgeon's career, post-training changes in surgical methods, and recurrence rates before and after training. RESULTS: We received responses from 159 of 300 trainees (53%). The mean career length was 12.7 ± 8.2 years. The annual number of transabdominal preperitoneal procedures performed increased from 20.9 ± 29.9 to 32.4 ± 56.1 after training (P < 0.001), and the number of totally extraperitoneal procedures increased from 9.5 ± 13.9 to 13.9 ± 16.9 (P = 0.0218). The annual number of procedures performed via the anterior approach decreased from 153.1 ± 28.4 to 28.4 ± 52.2 after training (P < 0.001). The pre-training transabdominal preperitoneal procedure recurrence rate was 0.9%, and this decreased to 0.4% after training. There was no pre-training recurrence rate for the totally extraperitoneal procedure, but this was 0.4% after training. CONCLUSION: The high recurrence rate after inguinal hernia repair in Japan was mainly due to inadequate training in the laparoscopic method. Our laparoscopic hernia repair training course achieved low recurrence rates.