What Is the Influence of Simulation-Based Training Courses, the Learning Curve, Supervision, and Surgeon Volume on the Outcome in Hernia Repair?—A Systematic Review

Köckerling, F.

doi:10.3389/fsurg.2018.00057

Cited by 43 publications

(53 citation statements)

References 83 publications

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“…It is well recognized that laparo-endoscopic surgical techniques are associated with a longer learning curve because of their increased complexity and skill required [19]. For example, the learning curve in the TEP technique for inguinal hernia repair may require up to 250 procedures, especially when taking into account all the outcome criteria [19]. For TAPP the learning curve is seen as approximately 50-100 procedures [19].…”

Section: Learning Curve For Laparoscopic and Open Abdominal Wall Surgerymentioning

confidence: 99%

“…For example, the learning curve in the TEP technique for inguinal hernia repair may require up to 250 procedures, especially when taking into account all the outcome criteria [19]. For TAPP the learning curve is seen as approximately 50-100 procedures [19]. Notwithstanding the higher learning curve in TEP and TAPP, the open mesh and non-mesh procedures also have a relevant and defined learning curve [19] which, if not followed correctly, could result in high recurrence and/or chronic pain rates [19].…”

Section: Learning Curve For Laparoscopic and Open Abdominal Wall Surgerymentioning

confidence: 99%

“…Notwithstanding the higher learning curve in TEP and TAPP, the open mesh and non-mesh procedures also have a relevant and defined learning curve [19] which, if not followed correctly, could result in high recurrence and/or chronic pain rates [19]. The laparoscopic IPOM technique in incisional hernia repair is associated with a recognized considerably higher complication rate, especially during the learning curve and therefore there is a strong recommendation that training in this operation is always under close supervision [19]. At present there are unfortunately no data available as such on the expected or recommended learning curve for the open surgical techniques used for incisional hernia repair [19].…”

Section: Learning Curve For Laparoscopic and Open Abdominal Wall Surgerymentioning

confidence: 99%

“…The laparoscopic IPOM technique in incisional hernia repair is associated with a recognized considerably higher complication rate, especially during the learning curve and therefore there is a strong recommendation that training in this operation is always under close supervision [19]. At present there are unfortunately no data available as such on the expected or recommended learning curve for the open surgical techniques used for incisional hernia repair [19]. But it can be assumed that the open techniques, such as the sublay operation, open IPOM and the component separation techniques, are associated with significantly longer learning curves than inguinal hernia repairs.…”

Section: Learning Curve For Laparoscopic and Open Abdominal Wall Surgerymentioning

confidence: 99%

“…Hence, implementation of any 'tailored' approach with 'mastery' and expertise developed in many operative procedures in abdominal wall surgery to come in line with the current guidelines will invariably significantly add to the already increasing demands on any surgeon. Appropriate training in line with the guidelines will generally rely on extensive training under the supervision of an experienced abdominal wall surgeon rather than on an ad hoc approach which can be assumed to be commonly employed in most general surgical training environments [19].…”

Section: Learning Curve For Laparoscopic and Open Abdominal Wall Surgerymentioning

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: Learning Curve For Laparoscopic and Open Abdominal Wall Surgerymentioning

confidence: 99%

Section: Learning Curve For Laparoscopic and Open Abdominal Wall Surgerymentioning

confidence: 99%

Section: Learning Curve For Laparoscopic and Open Abdominal Wall Surgerymentioning

confidence: 99%

Section: Learning Curve For Laparoscopic and Open Abdominal Wall Surgerymentioning

confidence: 99%

Section: Learning Curve For Laparoscopic and Open Abdominal Wall Surgerymentioning

confidence: 99%

See 3 more Smart Citations

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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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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Long‐Term Trends and Predictors of Medical Resource Utilization and Medical Outcomes in Inguinal Hernia Repair: A Nationwide Cohort Study

et al. 2021

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Background Few studies have comprehensively and systematically analyzed nationwide samples. This study purposed to explore temporal trends and predictors of medical resource utilization and medical outcomes in these patients to obtain data that can be used to improve healthcare policies and to support clinical and administrative decision‐making. Methods This study used nationwide population data contained in the Longitudinal Health Insurance Database of Taiwan. The 14,970 inguinal hernia repair patients were enrolled in this study (age range, 18–100 years) from 1997 to 2013 in Taiwan. After temporal trends analysis of demographic characteristics, clinical characteristics, and institutional characteristics, predictors of postoperative medical resource utilization and medical outcomes were evaluated through multiple linear regression analysis and Cox regression analysis. Results The prevalence of inguinal hernia repair per 100,000 population significantly decreased from 195.38 in 1997 to 39.66 in 2013 (p < 0.05). Demographic characteristics, clinical characteristics, and institutional characteristics were significantly associated with postoperative medical resource utilization and medical outcomes (p < 0.05). Of these characteristics, both surgeon volume and hospital volume had the strongest association. Conclusions The inguinal hernia repair prevalence rate gradually decreased during the study period. Demographic characteristics, clinical characteristics, and institutional characteristics had strong associations with postoperative medical resource utilization and medical outcomes. Furthermore, hospital volume and surgeon volume had the strongest associations with postoperative medical resource utilization and medical outcomes. Additionally, providing the education needed to make the most advantageous medical decisions would be a great service not only to patients and their families, but also to the general population.

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What Is the Influence of Simulation-Based Training Courses, the Learning Curve, Supervision, and Surgeon Volume on the Outcome in Hernia Repair?—A Systematic Review

Cited by 43 publications

References 83 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

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

Long‐Term Trends and Predictors of Medical Resource Utilization and Medical Outcomes in Inguinal Hernia Repair: A Nationwide Cohort Study

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