Learning curve in open groin hernia surgery: nationwide register-based study

Area of Science:

• General Surgery
• Surgical Education
• Hernia Repair Outcomes

Background:

• Current guidelines for surgical resident training in open groin hernia repair are inconsistent.
• This study investigates the learning curve for open anterior mesh repair of groin hernias.

Purpose of the Study:

• To determine the relationship between the number of open anterior mesh repairs performed by surgical residents and outcomes.
• To establish a data-driven benchmark for resident competency in groin hernia surgery.

Main Methods:

• Analysis of nationwide data from the Swedish Hernia Register (2005-2020).
• Inclusion of 38,845 open anterior mesh repairs by 663 general surgery residents.
• Exclusion of surgeons with fewer than 30 repairs to focus on established learning curves.

Main Results:

• Operating time decreased significantly with increasing procedure volume (79 min for first 15 vs. 60 min after 241 procedures).
• A significant decrease in complication rates was observed after 60 procedures (3.6% for 31-60 repairs vs. 2.7% for 61-120 repairs).
• No significant association was found between the number of procedures and hernia recurrence rates.

Conclusions:

• A benchmark of 60 open anterior mesh repairs is proposed for surgical residents.
• This volume is suggested to ensure safe and independent practice of groin hernia repair.
• The findings support the development of standardized training curricula for hernia surgery.