Sumio Matsumoto, PhD1, Tetsushi Hayakawa, Dr2, Yo Kawarada, Dr3, Kazunori Uchida, Dr4, Hidtoshi Wada, Senior, Assistant, Professor5, Toru Eguchi, Dr6, Nozomi Ueno, MD, PhD7, Hitoshi Idani, Dr8, Kanyu Nakano, MD, PhD8, Yoshiyuki Omomo9. 1Tokyo Medical Center, 2KARIYA TOYOTA General Hospital, Laparoscopic Hernia Surgery Center, 3KKR Tonan Hospital, 4Hiroshima Kosei Hospital, 5Hamamatsu University School of Medicine, 6Harasanshin Hospital, 7Yodogawa Christian Hospital, 8Hiroshima City Hiroshima Citizens Hospital, 9Covidien Japan
Background: As for groin hernia repair in Japan, laparoscopic repair started from 1991, however mesh plug repair prevailed since 1993 but turned to decrease 2006. Alternatively laparoscopic repair turn to increase again, of which recurrence rate was kept below 1.0% until 11th Japan Society for endoscopic Surgery (JSES) questionnaire, 2011. Recurrence rate increased to 4% in Trans-Abdominal Preperitoneal Procedure (TAPP) and 5% in Totally-Extraperitoneal Procedure (TEP) according to the result of 12th JSES 2013 questionnaire. It became serious problems of which procedure was correct.
Purpose: We held training courses in order to show appropriate laparoscopic repair at Advanced Training Center (Covidien Japan) 14 times from 2011.
Material and methods: Training contents consisted of groin anatomies, dry lab suturing training, video lecture by qualified surgeon of endoscopic surgical skill qualification system of JSES and animal lab. The number of participants reached to more than 300 up to April 2016. We made inquiries about kinds of their repair and the recurrence rate before and after the training course. Questionnaire included about postgraduate surgeon’s career, change of repair methods concept, actual repair and recurrence.
Results: We received answers from 159 participants (53%). Surgeons career was mean 12.7 years±8.2, As for repair methods change, TAPP was from 20.9±29.9 to 32.4±56.1 %(P<0.001), as for TEP was from 9.5±13.9 % to 13.9±16.9 %(P=0.0218). As for anterior approach, the number decreased from 153.1±28.4 to 28.4±52.2 (P<0.001). Recurrence rate by TAPP was 0.9% before lecture and it decreased to 0.4% after training. Recurrence by TEP was no previous value before training but 0.4% after training.
Discussion and conclusion: According to 12th JSES questionnaire, recurrence rate of TAPP and TEP was getting worse unexpectedly. The main reason why recurrence rate raised in JSES questionnaire was due to rapid spread of laparoscopic groin hernia repair without appropriate teaching. It might be ironical results by higher operative price which was induced by Ministry of health and welfare. Our training course recurrence rate were less than the results of JSES recent 2013 questionnaire. So, our laparoscopic hernia master course achieved valuable results.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79094
Program Number: P299
Presentation Session: Poster (Non CME)
Presentation Type: Poster