Page 96 - International guidelines for groin hernia management

Hernia

Evidence in literature supervised. A 2012 study 11 found an average 16 min
Learning Curve: Tissue Repair longer operative time for residents versus consultants on
Although some may consider primary tissue repair of groin procedures for 28,000 patients captured in the American
hernias to be easy and feasible, little is published about College of Surgeons National Surgical Quality Improve-
learning curves to independently perform a primary tissue ment Program (ACS-NSQIP), confirming earlier reports by
repair in groin hernia patients. Therefore, no statement can others. 12 In a recent study, 69 trainees were followed for
be made regarding the learning curve for tissue repair. The 7 years with case log review and standardized technical
mesh placement component of the open anterior approach competency assessments in UK NHS training programs.
is easier to learn for physicians already proficient in the On average, the trainees achieved proficiency for inde-
anterior tissue repair 7, 8 than for novices without any pendent IH repair after they had performed 64 repairs
experience in hernia repair. The following statements (range 12–73) which usually was reached in their fourth
derive from published literature regarding surgical trainees year of training. 13
in the mesh repair era. Learning Curve: Laparo-endoscopic Repair TEP Approach
Learning Curve: Open Repair Irrespective of the definition, there seems to be consensus
9
A registry study of 4406 patients demonstrated more that laparo-endoscopic IH repair has a distinct learning
recurrences if operating residents were unsupervised [un- curve. Evaluating learning curves in health technology is
supervised junior resident RR 21 (95% CI 7.3–58.9), challenging. 14
p \ 0.001]. Recurrence rates and operative times were also The figures below depict the reported complication rates
higher for junior residents (\ 4 years of postgraduate (Fig. 5), operative times (Fig. 6) and recurrence rates
10
training) in a large randomized trial where residents were (Fig. 7) in relation to procedure numbers from studies
retrieved in literature search. The learning curve for laparo-

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