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The learning curve in laparoscopic inguinal hernia repair for the community general surgeon
1Department of Surgery, Salvation Army Scarborough Grace Hospital, Ont. minaise@pathcom.com
Objective:
To determine the learning curve (number of operations required) to stabilize operating times and complication rates for a general surgeon doing laparoscopic inguinal hernia repair in a community practice.
Design:
A prospective analysis.
Setting:
A 256-bed secondary-care community hospital.
Patients:
Ninety-eight consecutive patients booked for elective laparoscopic hernia repair on an outpatient basis.
Interventions:
Using the transbdominal preperitoneal approach, 100 operations were carried out to repair 138 groins and a total of 164 separate hernial defects.
Outcome Measures:
The number of operations required to decrease operative times and complication rates to a steady level.
Results:
There were no deaths. There were 5 conversions and 10 admissions, all occurring between the 1st and 46th operations. Two reoperations for reasons other than recurrence were required between the 45th and 55th operations. There were 24 other complications. Complications and surgical times began to level off after 50 operations. The 1 readmission was after the 42nd operation. There were 4 recurrences (2.9% recurrence rate), 2 in each group of 50 operations. Both groups of 2 recurrence occurred within the first 10 operations involving the use of a new stapler. Twenty-two other patients had open hernia repairs because laparoscopy was unsuitable for them.
Conclusion:
The learning curve for laparoscopic inguinal hernia repair in the hands of a general surgeon in community practice who is experienced in open herniorraphy and laparoscopic cholecystectomy is at least 50 operations.