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Inguinal hernia surgery learning curves by associate clinicians.

Jurre van Kesteren1,2, Pauline J Meylahn-Jansen3,4, Amara Conteh5

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Associate clinicians master open inguinal hernia repair after 31-35 cases, significantly reducing operating time and length of stay. This data informs surgical training programs in low-resource settings.

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Area of Science:

  • Surgery
  • Surgical Education
  • Global Health

Background:

  • Open inguinal hernia repair is a common general surgery procedure in sub-Saharan Africa.
  • Data on the learning curve for this procedure in the region is limited.
  • This study addresses the need for data to improve surgical training and hernia repair scalability.

Purpose of the Study:

  • To evaluate the learning curve characteristics of open inguinal hernia repair for associate clinicians.
  • To provide data for improving surgical training programs in low- and middle-income countries.
  • To establish a baseline for future surgical training techniques in hernia repair.

Main Methods:

  • Analysis of logbook data from associate clinicians in a Sierra Leone surgical training program.
  • Inclusion of the first 55 open inguinal hernia repairs (herniorrhaphies) using the Bassini technique.
  • Evaluation of operating time, operating time variation, and length of stay (LOS) in cohorts of five cases.

Main Results:

  • Operating times decreased from a mean of 79.6 minutes to 48.6 minutes.
  • Standard deviation in operating time was reduced by nearly half.
  • Length of stay shortened by an average of 3 days, with times flattening after 31-35 cases.

Conclusions:

  • The learning curve for associate clinicians performing open inguinal hernia repair stabilizes after 31-35 procedures.
  • Findings can inform the tailoring of surgical training programs.
  • The established learning curve serves as a benchmark for future training innovations.