Laparoscopic Pediatric Inguinal Hernia Repair as a Training Platform for Surgical Residents

Training residents in pediatric laparoscopic surgery remains challenging due to the technical learning curve. Laparoscopic pediatric inguinal hernia repair is a standardized procedure with reproducible steps that may serve as an ideal operation for simulation-based surgical training.

Pediatric surgeons within the Kaiser Permanente Southern California system transitioned to a percutaneous laparoscopic approach for pediatric inguinal hernia repair in 2021. During this transition, residents were trained using a simulation-based curriculum followed by supervised operative participation. A retrospective review compared outcomes between cases performed by attending surgeons alone and those involving residents.

From 2020 to 2025, 784 patients underwent laparoscopic pediatric inguinal hernia repair. A total of 307 cases involved resident participation, and 477 were performed by attending surgeons alone. Patient age did not differ between groups (59.9 versus 54.8 mo, P = 0.193). Operative duration was longer in cases involving residents (38.2 versus 31.2 min, P < 0.001). Thirty-d emergency department visits occurred in 2.0% of patients and were similar between groups (0.9% versus 2.7%, P = 0.12), while 90-d emergency department visits were lower in the resident cohort (1.8% versus 4.5%, P = 0.049). However, hernia recurrence requiring reoperation at ≥2 y of follow-up was higher in the resident cohort (6.4% versus 1.8%, P = 0.026).

Resident participation in laparoscopic pediatric inguinal hernia repair was associated with longer operative duration and higher long-term hernia recurrence, while short-term postoperative outcomes remained comparable. These findings support the feasibility of resident participation in this standardized procedure under direct supervision and highlight the importance of continued technical refinement during surgical training.