Abstract：
OBJECTIVE: The TransREctus sheath PrePeritoneal procedure (TREPP) was introduced as an alternative open and preperitoneal technique for inguinal hernia mesh repair, demonstrating safety and efficacy in retro- and prospective studies. However, little is known about the technique\'s inherent learning curve. In this study, we aimed to determine TREPP learning curve effects after its implementation in high-volume surgical practice.
METHODS: All primary, unilateral TREPP procedures performed in the first three years after implementation (between January 2016 and December 2018) were included out of a large preconstructed regional inguinal hernia database. Data were analyzed on outcome (i.e., surgical complications, hernia recurrences, postoperative pain). Learning curve effects were analyzed by assessing outcome in relation to surgeon experience.
RESULTS: In total, 422 primary, unilateral TREPP procedures were performed in 419 patients. In three patients a unilateral TREPP procedure was performed on both sides separated in time. A total of 99 surgical complications were registered in 83 procedures (19.6% of all procedures), most commonly inguinal postoperative pain (8%) and bleeding complications (7%). Hernia recurrences were observed in 17 patients (4%). No statistically significant differences on outcome were found between different surgeon experience (< 40 procedures, 40-80 procedures, > 80 procedures).
CONCLUSIONS: Implementation of TREPP seems not to be associated with a notable increase of adverse events. We were not able to detect a clear learning curve limit, potentially suggesting a relatively short learning curve among already experienced hernia surgeons compared to other guideline techniques.
METHODS: All primary, unilateral TREPP procedures performed in the first three years after implementation (between January 2016 and December 2018) were included out of a large preconstructed regional inguinal hernia database. Data were analyzed on outcome (i.e., surgical complications, hernia recurrences, postoperative pain). Learning curve effects were analyzed by assessing outcome in relation to surgeon experience.
RESULTS: In total, 422 primary, unilateral TREPP procedures were performed in 419 patients. In three patients a unilateral TREPP procedure was performed on both sides separated in time. A total of 99 surgical complications were registered in 83 procedures (19.6% of all procedures), most commonly inguinal postoperative pain (8%) and bleeding complications (7%). Hernia recurrences were observed in 17 patients (4%). No statistically significant differences on outcome were found between different surgeon experience (< 40 procedures, 40-80 procedures, > 80 procedures).
CONCLUSIONS: Implementation of TREPP seems not to be associated with a notable increase of adverse events. We were not able to detect a clear learning curve limit, potentially suggesting a relatively short learning curve among already experienced hernia surgeons compared to other guideline techniques.
摘要：
目的：将Tranrectus鞘腹膜前手术（TREPP）作为腹股沟疝网片修补术的一种替代方法，在回顾性和前瞻性研究中证明安全性和有效性。然而,对这项技术固有的学习曲线知之甚少。在这项研究中,我们的目的是确定在大批量外科实践中实施TREPP后的学习曲线效果.
方法：所有主要，在实施后的前3年(2016年1月至2018年12月)进行的单侧TREPP手术纳入了大型预制区域性腹股沟疝数据库.对结果进行数据分析(即，手术并发症,疝气复发,术后疼痛）。通过评估与外科医生经验相关的结果来分析学习曲线效果。
结果：总计，422主要，419例患者进行了单侧TREPP手术.在三名患者中，在时间上分开的两侧进行了单侧TREPP手术。在83例手术（占所有手术的19.6％）中，共有99例手术并发症。最常见的腹股沟术后疼痛（8％）和出血并发症（7％）。17例患者(4%)出现疝复发。在不同的外科医生经验(<40次手术，40-80个程序，>80个程序)。
结论：实施TREPP似乎与不良事件的显著增加无关。我们无法检测到明确的学习曲线限制，与其他指导技术相比，这可能表明已经有经验的疝气外科医生的学习曲线相对较短。
方法：所有主要，在实施后的前3年(2016年1月至2018年12月)进行的单侧TREPP手术纳入了大型预制区域性腹股沟疝数据库.对结果进行数据分析(即，手术并发症,疝气复发,术后疼痛）。通过评估与外科医生经验相关的结果来分析学习曲线效果。
结果：总计，422主要，419例患者进行了单侧TREPP手术.在三名患者中，在时间上分开的两侧进行了单侧TREPP手术。在83例手术（占所有手术的19.6％）中，共有99例手术并发症。最常见的腹股沟术后疼痛（8％）和出血并发症（7％）。17例患者(4%)出现疝复发。在不同的外科医生经验(<40次手术，40-80个程序，>80个程序)。
结论：实施TREPP似乎与不良事件的显著增加无关。我们无法检测到明确的学习曲线限制，与其他指导技术相比，这可能表明已经有经验的疝气外科医生的学习曲线相对较短。
