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Learning curve for Lichtenstein hernioplasty

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Mark Wiese1, Thomas Kaufmann2, Jürg Metzger3, Guido Schüpfer4, Philipp Honigmann11Surgical Department, 2Quality and Risk Management, 3Visceral Surgery, 4Anaesthesiological Department, Cantonal Hospital Lucerne, Lucerne, SwitzerlandPurpose: In surgery the term ‘learning curve’ is often used to describe the phenomenon of acquiring the surgical skills to perform a specific operation safely, sufficiently and effectively without providing the exact amount of procedures needed. The learning curve in the field of open -inguinal hernia repair using an open mesh technique has not been evaluated so far. The purpose of this study is to specify exactly how many procedures are truly necessary to perform this kind of surgical procedure safely. The result of this study is hoped to impact the education of young surgeons, namely that a specific target number of procedures needed is considered when referring to the learning curve.Methods: Residents participating in this study were in their first 2 years and had assisted in Lichtenstein procedures before performing their first operation. The cut to suture time was recorded and a logarithmic fit model was used. The time difference between two surgical cases with regard for the influence on performance was also assessed.Results: Four hundred seventy-one patients with 489 primary uni- and bilateral inguinal hernias and 36 first year residents na ve for this procedure were included. The estimated cut to suture time reached 69 minutes (median) after 40 procedures. Nine mild adverse events occurred.Conclusion: Based on our data, we concluded that performing open hernioplasty under supervision is an effective and safe training method for young residents and it is a helpful method to differentiate between learning and nonlearning residents.Keywords: inguinal hernia, hernioplasty, Lichtenstein, learning curve


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