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Peer-reviewedCC BY-NC-SA 4.0Videosurgery and other Miniinvasive Techniques

Learning curve and early outcomes of transabdominal preperitoneal inguinal hernia repair after structured training: a 3-center study

  • Inez Bilińska1
  • Jakub Włodarczyk1
  • Marta Wójcik2
  • Michał Janik3
  • Mateusz Zamkowski4,5
  • Maciej Śmietański4,5
  • Kryspin Mitura6
  • Łukasz Dziki1
  • Marcin Włodarczyk1
6 affiliations
  1. 1Department of General and Oncological Surgery, Medical University of Lodz, Łódź, Poland
  2. 2Department of General and Minimally Invasive Surgery, Franciszek Raszeja Municipal Hospital, Poznań, Poland
  3. 3Clinic of General Surgery, Military Institute of Aviation Medicine, Warszawa, Poland
  4. 4Śmietański Hernia Center, LUX MED Hospital in Gdansk, Gdańsk, Poland
  5. 5Second Department of Radiology, Medical University of Gdansk, Gdańsk, Poland
  6. 6Faculty of Medical and Health Sciences, University of Siedlce, Siedlce, Poland
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Abstract

INTRODUCTION:: Transabdominal preperitoneal (TAPP) repair is an established technique for inguinal hernia repair, but technical complexity and safety concerns during the learning curve may limit its adoption.

AIM:: Our objective was to describe early operative safety and performance of 3 participating surgeons from 3 centers following training in the national “Hernia Master” program.

MATERIALS AND METHODS:: This multicenter retrospective study included 207 patients who underwent 240 elective TAPP groin hernia repairs during 207 sessions, including 33 bilateral procedures. Three trainees contributed 84, 63, and 60 sessions, respectively. Operative time (OT) was assessed using locally weighted scatterplot smoothing (LOWESS) and by comparing chronological halves. Postoperative complications were graded using the Clavien–Dindo classification, whereas intraoperative events and conversions were recorded separately. Surveillance was extended to 3 months, without standardized assessment of recurrence or chronic postoperative inguinal pain.

RESULTS:: Postoperative complications occurred in 5 of 240 repairs (2.1%) and did not differ significantly between phases. Intraoperative adverse events and conversions each occurred in 2 of 240 repairs (0.8%). In the reported analysis of OT, median time decreased for Surgeon 1 (70 vs 55 min; P <0.01). No significant difference was found in the case of Surgeon 2 (110 vs 95 min), whereas Surgeon 3 showed a nonsignificant trend toward shorter OT (75 vs 65 min; P = 0.09). LOWESS curves indicated continued improvement without a clear plateau.

CONCLUSIONS:: This selected 3-surgeon cohort demonstrates early safety and operative performance following structured training. The findings cannot establish the effectiveness of the program as a whole, a threshold for proficiency, or long-term treatment quality. Prospective evaluation of all trainees, with standardized assessments of recurrence and chronic postoperative inguinal pain, is needed.

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Cite

BibTeXRIS
BibTeX
@article{bilinska2026learning,
  title = {{Learning curve and early outcomes of transabdominal preperitoneal inguinal hernia repair after structured training: a 3-center study}},
  author = {Inez Bilińska and Jakub Włodarczyk and Marta Wójcik and Michał Janik and Mateusz Zamkowski and Maciej Śmietański and Kryspin Mitura and Łukasz Dziki and Marcin Włodarczyk},
  journal = {Videosurgery and other Miniinvasive Techniques},
  year = {2026},
  month = oct,
  doi = {10.20452/wiitm.2026.18052},
  url = {https://doi.org/10.20452/wiitm.2026.18052},
  note = {CC BY-NC-SA 4.0},
}
RIS
TY  - JOUR
TI  - Learning curve and early outcomes of transabdominal preperitoneal inguinal hernia repair after structured training: a 3-center study
AU  - Inez Bilińska
AU  - Jakub Włodarczyk
AU  - Marta Wójcik
AU  - Michał Janik
AU  - Mateusz Zamkowski
AU  - Maciej Śmietański
AU  - Kryspin Mitura
AU  - Łukasz Dziki
AU  - Marcin Włodarczyk
PY  - 2026
DA  - 2026/10/21
JO  - Videosurgery and other Miniinvasive Techniques
DO  - 10.20452/wiitm.2026.18052
UR  - https://doi.org/10.20452/wiitm.2026.18052
AB  - INTRODUCTION:: Transabdominal preperitoneal (TAPP) repair is an established technique for inguinal hernia repair, but technical complexity and safety concerns during the learning curve may limit its adoption.  AIM:: Our objective was to describe early operative safety and performance of 3 participating surgeons from 3 centers following training in the national “Hernia Master” program.  MATERIALS AND METHODS:: This multicenter retrospective study included 207 patients who underwent 240 elective TAPP groin hernia repairs during 207 sessions, including 33 bilateral procedures. Three trainees contributed 84, 63, and 60 sessions, respectively. Operative time (OT) was assessed using locally weighted scatterplot smoothing (LOWESS) and by comparing chronological halves. Postoperative complications were graded using the Clavien–Dindo classification, whereas intraoperative events and conversions were recorded separately. Surveillance was extended to 3 months, without standardized assessment of recurrence or chronic postoperative inguinal pain.  RESULTS:: Postoperative complications occurred in 5 of 240 repairs (2.1%) and did not differ significantly between phases. Intraoperative adverse events and conversions each occurred in 2 of 240 repairs (0.8%). In the reported analysis of OT, median time decreased for Surgeon 1 (70 vs 55 min; P <0.01). No significant difference was found in the case of Surgeon 2 (110 vs 95 min), whereas Surgeon 3 showed a nonsignificant trend toward shorter OT (75 vs 65 min; P = 0.09). LOWESS curves indicated continued improvement without a clear plateau.  CONCLUSIONS:: This selected 3-surgeon cohort demonstrates early safety and operative performance following structured training. The findings cannot establish the effectiveness of the program as a whole, a threshold for proficiency, or long-term treatment quality. Prospective evaluation of all trainees, with standardized assessments of recurrence and chronic postoperative inguinal pain, is needed.
SN  - 1895-4588
SN  - 2299-0054
ER  -