Analysis of outcome of Lichtenstein groin hernia repair by surgeons in training versus a specialized surgeon
2011 (English)In: Hernia, ISSN 1265-4906, E-ISSN 1248-9294, Vol. 15, no 3, 281-288 p.Article in journal (Refereed) Published
Purpose: Groin hernia repair is a common procedure in general surgery, and is taught to and performed by surgeons early in their training. The aim of this observational study was to compare hernia repair performance and results of surgical trainees with those of a specialized surgeon. The further aim sought to identify what factors may influence short and long-term outcome, and areas for improvement in surgical training.
Methods: A non-randomized parallel cohort study was designed to compare a specialized surgeon with surgical trainees, performing the Lichtenstein repair in adult males. Two hundred repairs were included, of which 96 were performed by surgical trainees. Patient characteristics, surgical experience, and operative data including duration of procedural parts and surgical complexity were noted at surgery. Postoperative complications, recurrence, chronic pain and residual symptoms were assessed at longterm follow-up after a median of 34.5 months.
Results: Surgical trainees had longer overall operative time consume, with an unproportionally longer time for mobilising the sac and cord. They perceived exposure and mobilisation as more difficult than the specialist, and also a greater demand on own experience during surgery. The trainee repairs had a higher rate of postoperative complications (14.7% versus 5.0%) but recurrence rate was the same as for specialist repairs. At long-term follow-up, specialist repairs had a higher symptom burden and more chronic pain.
Conclusions: Comparison of a specialized surgeon to surgical trainees in performance and outcome for inguinal hernia surgery shows it was more efficient, but not necessarily better to let a specialized surgeon perform the repairs. The better long-term outcome for surgical trainees stands in contrast to the prejudice that it is better to have an experienced surgeon to perform standard procedures. It seems likely that targeted training in dissection and mobilisation could decrease level of perceived complexity and shorten operative time consume for surgical trainees. We believe that adequately supervised hernia surgery should remain as a part of the surgical training.
Place, publisher, year, edition, pages
Springer , 2011. Vol. 15, no 3, 281-288 p.
Groin hernia, Surgical trainees, Lichtenstein, Pain
National CategoryMedical and Health Sciences
IdentifiersURN: urn:nbn:se:liu:diva-63643DOI: 10.1007/s10029-010-0780-yISI: 000291603300006OAI: oai:DiVA.org:liu-63643DiVA: diva2:382058