Outcomes of a structured training programme for paediatric laparoscopic inguinal hernia repair

A structured training programme for laparoscopic paediatric inguinal hernia (LPIH) repair was devised. This programme was evaluated to ensure patient safety by assessing long-term outcomes of operated patients.

Training Programme - Trainees undergo at least monthly consultant-supervised simulation sessions using the LPIH model. They then undertake live-operating in a step-wise progression: (A) laparoscopic ports insertion and wound closure, (B) intra-corporeal knot tying, and (C) purse-string suturing of hernial orifice. Study - All patients undergoing LPIH repair from July 2003 to Sept 2011 were analysed. Trainee involvement was recorded prospectively, and patients were classified: Group 1 - Consultant only; Group 2 - Trainee performed step A; Group 3 - Trainee performed steps A & B; Group 4 - Trainee performed all steps.

224 patients were identified (175 male; 49 female). Average age at surgery was 2.2 years [range: premature (35/40 weeks) to 15 years]. The laterality of the inguinal hernia was: right (n=133), left (n=75), bilateral (n=16). Primary operator was defined as Group 1 n=88 (39%), Group 2 n=25 (12%), Group 3 n=57 (25%), and Group 4 n=54 (24%). Hernia recurrence occurred in 2 (1.8%) children where consultant operated and two (1.8%) where a trainee operated. Post-operative groin swelling (resolved spontaneously) occurred in 2 (1.8%) where consultant operated and 2 (1.8%) of the trainee cases. There were 3 children with iatrogenic post-operative cryptorchidism requiring subsequent orchidopexy, all from Group 3.

This study shows that comparable outcomes can be achieved with a structured training programme for LPIH repair for trainees. The exception appears to be iatrogenic cryptorchidism that only occurred in trainee Group 3.