How to teach and learn transabdominal preperitoneal effectively – Experience with introducing transabdominal preperitoneal repair in ten general hospitals in Slovenia (2013–2018)

Abstract

INTRODUCTION: Laparoscopic inguinal hernia repair, according to indications, should be offered to every patient in developed countries nowadays. However, in Slovenia, before 2013, only two hospitals (among 13) performed laparoendoscopic procedures routinely for the treatment of inguinal hernias. Besides, until 2016, the Health Insurance Institute of Slovenia (ZZZS) refunded costs according to diagnosis and not procedure and therefore did not stimulate introduction of more costly surgical procedures, such as transabdominal preperitoneal (TAPP) into daily practice. Many hospitals avoided TAPP as a nonprofitable procedure. METHODS: In 2012, the Slovenian Hernia Society hosted Prof. Dr. Reinhard Bittner as invited guest for teaching laparoscopic and open techniques. The symposium was followed by workshops with hands-on possibility in different hospitals. Soon thereafter, many TAPP and other workshops followed in local hospitals, organized by tutors of the Slovenian Hernia Society (about five workshops a year). Official meetings between the Slovenian Hernia Society and the ZZZS were organized. RESULTS: Between the years 2013 and 2018, ten more hospitals (one clinical center and nine general hospitals) started with TAPP procedures on a daily basis after more workshops were organized in their own local surgical department. In every hospital, one or more surgeons were delegated to take responsibility for hernia surgery development in their own department. The health insurance system agreed to raise refund for bilateral inguinal hernia repair. CONCLUSIONS: Availability of laparoscopic inguinal hernia repair in the 3rd millennium should be a must in every EU country. TAPP was successfully introduced and consolidated as inguinal hernia repair technique in ten more hospitals across Slovenia in a relatively short period of 6 years (2013–2018).