Impact of training on outcomes following incisional hernia repair

The purpose of this study was to quantify the effect of training on clinical outcomes following elective incisional hernia repair.

The case notes of 100 consecutive elective open and laparoscopic incisional hernia repair procedures performed between January 2004 and July 2008 were reviewed retrospectively. Cases were performed either by consultant surgeons or trainees operating under direct supervision. The proportion of cases performed by trainees was recorded and the seniority of the operating surgeon related to peri- and post-operative outcomes as well as long-term recurrence rates.

Of the 100 cases, 61 were performed by consultants and 39 by trainees. There were no significant demographic differences between the two groups. Trainees undertook a similar proportion of laparoscopic cases as compared with consultants (44% vs. 44%). In addition, the operating time (60 +/- 4 mins vs. 58 +/- 4 mins), length of hospital stay (3.0 +/- 0.3 days vs. 3.3 +/- 0.3 days) and post-operative morbidity rates (18 % vs 10%) were similar between the two groups. At a mean follow-up period of 2.82 +/- 0.17 years, the incidence of recurrent herniae was lower in the trainee group, however this was not statistically significant (8% vs 16% ; p = 0.22).

Supervised trainees can successfully undertake both open and laparoscopic incisional hernia repairs with no detrimental effects on overall hospital costs, post-operative morbidity and long-term recurrence rates.