Is there an end of the “learning curve” of endoscopic totally extraperitoneal (TEP) hernia repair?

Background An important challenge of totally extraperitoneal (TEP) hernia repair is the learning curve. The European guidelines suggest that the learning curve ranges between 50 and 100 procedures, with the first 30–50 being critical. Others suggest that optimal outcomes are achieved after 200 or more TEP procedures. Methods All TEP repairs performed between 2005 and 2009 were included in this study. The effect of (surgeon) expertise on perioperative complications, conversion to open anterior repair, and operative time was assessed to evaluate the extent of the learning curve of TEP repair. Results Intraoperative complications occurred in