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Total Extraperitoneal Hernia Repair: Residency Teaching Program and Outcome Evaluation.

Fabio Garofalo1,2, Pau Mota-Moya3, Andrew Munday3

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Summary

Supervised senior residents can safely perform total extraperitoneal (TEP) hernia repairs, demonstrating comparable safety to staff surgeons. This finding supports the routine inclusion of TEP training in general surgery residency programs.

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Area of Science:

  • Minimally Invasive Surgery
  • Surgical Education
  • Hernia Repair

Background:

  • Total extraperitoneal (TEP) repair offers advantages over open surgery, including reduced pain and shorter recovery times.
  • TEP is routinely performed at our institution for inguinal hernias.
  • The study aimed to assess the safety and efficacy of TEP repairs performed by supervised senior residents.

Purpose of the Study:

  • To evaluate the safety and outcomes of TEP hernia repairs conducted by senior surgical residents under supervision.
  • To compare the complication rates and operative times between resident-performed and staff surgeon-performed TEP repairs.
  • To determine the feasibility of incorporating TEP training into general surgery residency curricula.

Main Methods:

  • Retrospective analysis of a prospective database of consecutive patients undergoing laparoscopic TEP repair from October 2008 to June 2012.
  • Inclusion of all primary and recurrent inguinal hernia repairs performed by supervised senior residents and staff surgeons.
  • Data collection focused on patient demographics, operative details, and 30-day postoperative morbidity.

Main Results:

  • A total of 219 TEP repairs were performed on 171 patients, with residents performing 78% of procedures.
  • Overall complication rates were similar between residents (19.3%) and staff surgeons (18.7%), with no statistically significant difference (p=0.83).
  • Mean operative times for unilateral repairs were longer for residents (77.6 min) compared to staff surgeons (65 min) (p=0.043), while bilateral repair times showed no significant difference.

Conclusions:

  • Supervised senior residents can safely perform total extraperitoneal (TEP) hernia repairs.
  • The complication profile for resident-performed TEPs is comparable to that of experienced staff surgeons.
  • Routine inclusion of TEP repair training in general surgery residency programs is recommended.