Meta-analysis of operative experiences of general surgery trainees during training

Elsey, Elizabeth; Griffiths, Gareth; Humes, David J.; West, Joe

doi:10.1002/bjs.10396

Cited by 47 publications

(41 citation statements)

References 40 publications

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“…What is apparent in contemporary training was demonstrated by a meta-analysis of 12 studies that reported the actual numbers of inguinal hernia repairs performed by general surgery trainees [15]. Two of these studies were from the UK, one from Thailand and nine from the USA [58][59][60][61][62][63][64][65][66][67][68][69].…”

Section: General Surgery Training and Hernia Repairmentioning

confidence: 99%

“…"General surgery training has the intention of training surgeons to a standard for independent practice" [15]. "But there is no worldwide standardization of expected operative experience in general surgery training and various surgical curricula requirements invariably will differ" [15]. "For example, the UK demands 1600 procedures by completion of training and the USA requires 750" [15].…”

Section: Introductionmentioning

confidence: 99%

“…"But there is no worldwide standardization of expected operative experience in general surgery training and various surgical curricula requirements invariably will differ" [15]. "For example, the UK demands 1600 procedures by completion of training and the USA requires 750" [15]. In addition to appendectomy, cholecystectomy and partial colectomy, inguinal/femoral and ventral hernia repairs are listed as part of the core procedures in general surgery training [16].…”

Section: Introductionmentioning

confidence: 99%

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The reality of general surgery training and increased complexity of abdominal wall hernia surgery

Köckerling

Sheen

Berrevoet

et al. 2019

Hernia

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Introduction The Accreditation and Certification of Hernia Centers and Surgeons (ACCESS) Group of the European Hernia Society (EHS) recognizes that there is a growing need to train specialist abdominal wall surgeons. The most important and relevant argument for this proposal and statement is the growing acceptance of the increasing complexity of abdominal wall surgery due to newer techniques, more challenging cases and the required 'tailored' approach to such surgery. There is now also an increasing public awareness with social media, whereby optimal treatment results are demanded by patients. However, to date the complexity of abdominal wall surgery has not been properly or adequately defined in the current literature. Methods A systematic search of the available literature was performed in May 2019 using Medline, PubMed, Scopus, Embase, Springer Link, and the Cochrane Library, with 75 publications identified as relevant. In addition, an analysis of data from the Herniamed Hernia Registry was performed. The percentage of patients with hernia-or patient-related characteristics which unfavorably impacted the outcome of inguinal and incisional hernia repair was also calculated. Results All present guidelines for abdominal wall surgery recommend the utilization of a 'tailored' approach. This relies on the prerequisite that any surgical technique used has already been mastered, as well as the recognized learning curves for each of the several techniques that can be used for both inguinal hernia (Lichtenstein, TEP, TAPP, Shouldice) and incisional hernia repairs (laparoscopic IPOM, open sublay, open IPOM, open onlay, open or endoscopic component separation technique).Other hernia-and patient-related characteristics that have recognized complexity include emergency surgery, obesity, recurrent hernias, bilateral inguinal hernias, groin hernia in women, scrotal hernias, large defects, high ASA scores, > 80 years of age, increased medical risk factors and previous lower abdominal surgery. The proportion of patients with at least one of these characteristics in the Herniamed Hernia Registry in the case of both inguinal and incisional hernia is noted to be relatively high at around 70%. In general surgery training approximately 50-100 hernia repairs on average are performed by each trainee, with around only 25 laparo-endoscopic procedures. Conclusion A tailored approach is now employed and seen more so in hernia surgery and this fact is referred to and highlighted in the contemporaneous hernia guidelines published to date. In addition, with the increasing complexity of abdominal wall surgery, the number of procedures actually performed by trainees is no longer considered adequate to overcome any recognized learning curve. Therefore, to supplement general surgery training young surgeons should be offered a clinical fellowship to obtain an additional qualification as an abdominal wall surgeon and thus improve their clinical and operative experience under supervision in this field. Practicing general surgeons with a special int...

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Section: General Surgery Training and Hernia Repairmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The reality of general surgery training and increased complexity of abdominal wall hernia surgery

Köckerling

Sheen

Berrevoet

et al. 2019

Hernia

View full text Add to dashboard Cite

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“…During each rotation, trainees must perform or assist in a minimum of 100 ‘major’ surgical cases per rotation (i.e. a minimum of 800 ‘major’ procedures in total) . Humanitarian and disaster surgery is referenced in the general surgery syllabus, with trainees required to demonstrate a ‘clear understanding of a potential disaster, humanitarian and military responsibilities of a general surgeon’ .…”

Section: Contemporary General Surgical Trainingmentioning

confidence: 99%

“…a minimum of 800 'major' procedures in total). 30 Humanitarian and disaster surgery is referenced in the general surgery syllabus, with trainees required to demonstrate a 'clear understanding of a potential disaster, humanitarian and military responsibilities of a general surgeon'. 29 After fellowship, many general surgeons undertake further training in subspecialties including hepato-pancreatico-biliary, upper gastrointestinal, breast and endocrine, colorectal and trauma.…”

Section: Contemporary General Surgical Trainingmentioning

confidence: 99%

Australasian general surgical training and emergency medical teams: a review

Coventry

Holland

Read

et al. 2019

ANZ Journal of Surgery

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Emergency medical teams (EMTs) have provided surgical care in sudden‐onset disasters in low‐ and middle‐income countries. General surgeons have been heavily involved in many EMTs due to their traditional broad set of surgical skills and experience. With the increased subspecialization of general surgical training in many high‐income countries, including Australia and New Zealand, finding general surgeons with adequately broad experience is becoming more challenging. Furthermore, it is now considered standard for EMTs deploying to a sudden‐onset disaster to have undergone credentialing, demonstrating sufficient training of their deployed members. The purpose of this review was to highlight the challenges and potential solutions facing those involved in training and recruiting general surgeons for EMTs in Australasia.

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Risk of Reoperation for Recurrence After Elective Primary Groin and Ventral Hernia Repair by Supervised Residents

et al. 2023

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ImportanceSurgical training involves letting residents operate under supervision. Since hernia repair is a common procedure worldwide, it is a frequent part of the surgical curriculum.ObjectiveTo assess the risk of reoperation for recurrence after elective primary groin and ventral hernia repair performed by supervised residents compared with that by specialists.Design, Setting, and ParticipantsThis nationwide register-based cohort study included data from January 2016 to September 2021. Patients were followed up until reoperation, emigration, death, or the end of the study period. The study used data from the Danish Inguinal and Ventral Hernia Databases linked with data from the Danish Patient Safety Authority’s Online Register via surgeons’ unique authorization ID.The cohort included patients aged 18 years or older who underwent primary elective hernia repairs performed by supervised residents or specialists for inguinal, femoral, epigastric, or umbilical hernias. Hernia repairs were divided into the following 4 groups: Lichtenstein groin, laparoscopic transabdominal preperitoneal (TAPP) groin, open ventral, and laparoscopic ventral.ExposuresHernia repairs performed by supervised residents vs specialists.Main Outcomes and MeasuresReoperation for recurrence, analyzed separately for all 4 groups.ResultsA total of 868 specialists and residents who performed 31 683 primary groin and 7777 primary ventral hernia repairs were included in this study. The median age of patients who underwent hernia repair was 60 years (IQR, 48-70 years), and 33 424 patients (84.7%) were male. There was no significant difference in the adjusted risk of reoperation after Lichtenstein groin hernia repair (hazard ratio [HR], 1.26; 95% CI, 0.99-1.59), laparoscopic groin hernia repair (HR, 1.01; 95% CI, 0.73-1.40), open ventral hernia repair (HR, 0.89; 95% CI, 0.61-1.29), and laparoscopic ventral hernia repair (HR, 2.96; 95% CI, 0.99-8.84) performed by supervised residents compared with those by specialists. There was, however, a slightly increased unadjusted, cumulative reoperation rate after Lichtenstein repairs performed by supervised residents compared with those by specialists (4.8% vs 4.2%; P = .048).Conclusions and RelevanceThe findings of this study suggest that neither open nor laparoscopic repair of groin and ventral hernias performed by supervised residents appeared to be associated with a higher risk of reoperation for recurrence compared with the operations performed by specialists. This indicates that residents may safely perform elective hernia repair when supervised as part of their training curriculum.

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Meta-analysis of operative experiences of general surgery trainees during training

Cited by 47 publications

References 40 publications

The reality of general surgery training and increased complexity of abdominal wall hernia surgery

The reality of general surgery training and increased complexity of abdominal wall hernia surgery

Australasian general surgical training and emergency medical teams: a review

Risk of Reoperation for Recurrence After Elective Primary Groin and Ventral Hernia Repair by Supervised Residents

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