Ten-year audit of Lichtenstein hernioplasty under local anaesthesia performed by surgical residents

Training of tension-free Lichtenstein hernia operation was started in our ambulatory unit as an outpatient procedure under local anaesthesia in 1996. After performing 36 teaching operations together with residents and their supervising specialist, 281 patients were operated during 1996-2000 either by one senior consultant (n = 141) or by 12 surgical trainees (n = 140). After 10 years, 247 (88%) patients were available for the long-term assessment.After one month postoperatively, the rate of wound infections (consultant 1.1%, residents 0.7%) and hematomas (consultant 1.1%, residents 3.0%) were low and not related to surgeon's training level (ns). Only 6 (2.1%) clinically evident recurrences were found after 10 years: two after specialist repair and four after trainee repair (ns). Although one third of the patients reported some discomfort after 3 and 10 years, 93-95% of the patients were very satisfied with the operation, with no statistical difference between the surgeons.Ambulatory open mesh repair under local anaesthesia was a safe operation and the long-term results were acceptable among the patients operated by surgical trainees.Inguinal hernias occur in about 15% of adult men and hernioplasty is the most common surgical procedure performed by general surgeons [1]. Approximately 11 000 inguinal hernioplasties are performed each year in Finland, over 80 000 operations in England and over 800 000 in the United States [1-3]. In Scandinavian countries, the majority of groin hernias are currently operated in ambulatory surgical units. About 20% of groin hernia repairs are done due to recurrences and only 4% as emergency [1-3]. The economical impact of groin hernia surgery is high on the health care system.There is strong evidence that surgeon's case volume, hospital volume and specialisation improve the outcome of many major surgical procedures, such as coronary artery bypass, gastrectomy, esophagectomy, pancreaticoduodenectomy and rectal cancer surgery [4,5]. The ro