Surg Today (2011) 41:216–221 DOI 10.1007/s00595-010-4266-4 Reprint requests to: Z. Pogorelic ´ Received: October 13, 2009 / Accepted: January 17, 2010 Original Article Laparoscopic Transabdominal Preperitoneal Approach for Inguinal Hernia Repair: A Five-Year Experience at a Single Center Zdravko Perko 1 , Mislav Rakic ´ 2 , Zenon Pogorelic ´ 3 , Nikica Družijanic ´ 1 , and Jasenka Kraljevic ´ 1 Departments of 1 Surgery and 3 Pediatric Surgery, University Hospital Split and Split University School of Medicine, Spinc ˇic´eva 1, 21 000 Split, Croatia 2 Department of Surgery, Dubrava Clinical Hospital, Avenija Gojka Šuška 6, 10 000 Zagreb, Croatia Abstract Purpose. Laparoscopic hernia repair has emerged as an effective alternative method for treating inguinal hernias. It has several significant advantages over the tension-free open repair now in use. In this report we summarize our laparoscopic hernia repair results and recommendations. Methods. The transabdominal preperitoneal (TAPP) procedures for groin hernias performed between January 2003 and January 2008 at a single center were analyzed retrospectively. Individual surgeon perfor- mances were compared to determine whether the rates of complications were related to the level of surgeon experience. Results. A total of 312 TAPP procedures were reviewed, and 284 (91%) of the patients were followed retrospec- tively. There were 266 (85.25%) males and 46 (14.75%) females. The average age was 57.4 years. The mean length of hospital stay was 2.1 days. The mean duration of surgery was 35 min. Six (1.92%) intraoperative and seven (2.24%) postoperative complications were noted. Two recurrences occurred (0.70%). Conclusions. Laparoscopic TAPP hernia repair has proven to be an efficient method for the treatment of groin hernias at our institution. Most patients can be treated as day-cases, namely they are hospitalized for 1 day, and they demonstrate a low recurrence rate (0.70%). Such low morbidity makes TAPP an attractive method for the routine treatment of groin hernias. Key words Inguinal hernia · Inguinal hernioplasty · Laparoscopy · Transabdominal preperitoneal approach · Learning curve Introduction Inguinal hernias are a common medical problem that can significantly decrease the quality of life. Laparo- scopic inguinal hernia repair has shown a great deal of promise as a treatment for the condition. 1 Several studies have demonstrated advantages of laparoscopic over open repair with regard to reduced postoperative pain and an earlier return to work and normal activi- ties. 2–6 Data concerning the recurrence of hernias remain controversial, with rates ranging from 0% to 15% for laparoscopic repair as compared with rates of 0.1% to 4.9% reported for repair using an open technique. 7 The limitations and complications of transabdominal pre- peritoneal (TAPP) hernia repair have been discussed extensively. However, reports in the literature tend to focus on multicenter, retrospective studies, and assess different techniques simultaneously. 8–17 The complication rates for TAPP were no higher than those reported for conventional repairs, but new and sometimes unique complications were seen. The data available show an incidence of complications ranging from 6.3% to 15.3% during the learning curve, which decreases to between 2.5% and 7.4% when performed by surgeons more experienced in laparoscopic hernia repair. 8–17 However, these findings are fragmented and do not provide a coherent basis for clear conclusions to be drawn. Furthermore, when repairing recurrent hernias, it does offer an advantage of transabdominal dissection through a previously nondamaged area. Bilateral hernias can be repaired without any additional incisions, and recovery for these patients is much faster than for open procedures. However, unlike laparoscopic cholecystectomy, laparoscopic herniorrhaphy has not been embraced by the surgical community mainly because it requires proficient laparoscopic techniques, and for this reason there is a longer learning curve. The laparoscopic operation exposes the patient to potential complications, mainly with respect to possible visceral