Hernia Repair Approaches Vary: A Case for Including Private Surgeons in Residency Training

Area of Science:

• General Surgery
• Surgical Education
• Hernia Repair Techniques

Background:

• Hernia repair is a prevalent general surgical procedure.
• Advancements in surgical techniques continuously evolve the field.
• Surgical residency programs can benefit from exposure to diverse hernia repair techniques and practice patterns.

Purpose of the Study:

• To compare inguinal hernia repair (IHR) and ventral hernia repair (VHR) practice patterns.
• To analyze differences among surgeons with academic (AA), private-with-academic (PWA), and private (PA) affiliations.
• To inform residency rotation planning for comprehensive hernia care training.

Main Methods:

• Retrospective cohort analysis of 108,137 hernia repairs (2013-2023) from the Abdominal Core Health Quality Collaborative (ACHQC).
• Outcomes analyzed: operative approach (open, laparoscopic, robotic), mesh placement, defect size, ASA class, and urgency.
• Statistical comparisons included chi-squared tests and ANOVA, with significance set at α=0.01.

Main Results:

• Significant practice pattern differences observed across AA, PWA, and PA surgeons.
• PA surgeons most frequently used robotic approaches for IHR/VHR and non-mesh IHR.
• AA surgeons managed sicker patients with more complex VHR and larger defects; PWA/PA surgeons used intraperitoneal mesh more often.
• Robotic utilization increased across all settings, with PA adopting it earliest and PWA showing highest VHR share recently.

Conclusions:

• Practice setting is a strong determinant of hernia repair patterns.
• Incorporating private practice surgeons into residency training offers broader exposure to techniques like open tissue-based IHR and robotic repairs.
• This collaboration can significantly augment resident training and experience in common hernia repair operations.