Inguinal hernia repair: see one, do one, teach one?

Area of Science:

• Surgical education
• Hernia surgery outcomes

Background:

• Clinical management of inguinal hernias is under debate.
• Evidence suggests trainee surgeons have inferior results compared to experienced surgeons.
• Limited data exists on current training and supervision levels for junior surgeons.

Purpose of the Study:

• To quantify the training and supervision experienced by junior surgeons performing inguinal hernia repairs.
• To assess trainee perceptions of their preparedness for unsupervised surgery.

Main Methods:

• A questionnaire survey was distributed to 32 surgical trainees (senior house officers and registrars) in Southern England.
• Data collected included assisted and supervised inguinal hernia repairs recorded in logbooks.
• Trainees reported on their experience before, during, and after their first unsupervised repair.

Main Results:

• Trainees assisted in a median of 8 repairs and were supervised in a median of 9 repairs before operating unsupervised.
• Significant variation exists in the volume of training and supervision received.
• Senior house officers reported more experience with Shouldice and Lichtenstein techniques than registrars.

Conclusions:

• While substantial variation in training exists, junior surgeons generally progress well through stages of assisting, supervision, and post-unsupervised reinforcement.
• Most trainees (79%) felt adequately trained for their first unsupervised inguinal hernia repair.
• The Shouldice and Lichtenstein techniques appear increasingly integrated into surgical training programs.