examining all endoscopic, major, and minor procedures performed by all New Zealand general surgery trainees in every training hospital in New Zealand. MAIN OUTCOMES AND MEASURESThe primary outcome was the level of meaningful autonomy by each New Zealand general surgery trainee (ie, trainee as primary operator without the surgeon mentor scrubbed for the case). Outcomes were compared using multivariable analysis. RESULTSThis study included 120 New Zealand general surgery trainees (42 women [35%] and 78 men [65%]) who were analyzed over 279.5 trainee-years (88.5 trainee-years for women and 191.0 trainee-years for men). Included were 119 380 general surgery procedures (17 465 endoscopic, 56 964 major, and 44 951 minor) in 18 hospitals. By the end of the 5-year training program, female trainees had a lower cumulative mean autonomous caseload than male trainees for endoscopic (284.0 [95% CI, 207.0-361.0] vs 352.2 [95% CI, 282.9-421.6], P = .03), major (139.9 [95% CI,.0], P = .02), and minor (456.3 [95% CI,.9] vs 519.9 [95% CI, 465.6-574.2], P = .007) procedures. CONCLUSIONS AND RELEVANCEAfter accounting for differences among trainees, hospital type, number of female and male surgeon mentors at each hospital, and trainee seniority, female trainees performed fewer cases with meaningful autonomy compared with male trainees. These findings support the need for pragmatic solutions to address this bias and further investigations on mechanisms contributing to discrepancies.

BackgroundHernia repair surgery using synthetic mesh is the standard of care in modern surgery. Complications from uro‐gynaecological mesh have been reported in the New Zealand media and there is public concern regarding the use of any mesh for any reason. This study reports long‐term outcomes in inguinal hernia surgery in a large cohort of elective operations using mesh.MethodsA prospective database of patients having inguinal hernia mesh repairs was maintained in a private two surgeon practice from 2002 to 2016. Patient demographics, method of repair, the pre‐operative and post‐operative pain scores and complications following surgery were recorded.ResultsA total of 1711 hernia in 1366 patients were repaired from 2002 to 2016. One thousand and forty‐seven repairs were laparoscopic total extraperitoneal (LTEP), 333 were open. Post‐operative pain scores were significantly lower than pre‐operative scores in inguinal hernia repair by any method. Only 22% of patients described no pain pre‐operatively and this rose to 76% post‐operatively; conversely 7.9% described severe pain pre‐operatively and this reduced to 1% post‐operatively. The recurrence rate for open inguinal hernia was zero and for LTEP repair was 0.81%.ConclusionInguinal hernia repair using mesh does not appear to produce significant rates of chronic pain long term. Overall, the complications from open or LTEP inguinal hernia repair with mesh are low.