A survey of general surgeons regarding laparoscopic inguinal hernia repair: practice patterns, barriers, and educational needs

Trevisonno, Michael; Kaneva, Pepa; Watanabe, Yusuke; Fried, Gerald M.; Feldman, Liane S.; Lebedeva, E. V.; Vassiliou, Melina C.

doi:10.1007/s10029-014-1287-8

Cited by 64 publications

(30 citation statements)

References 19 publications

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“…They were most likely to seek education in a course followed by expert proctoring. 36 The learning curve for the laparoscopic techniques may be significant enough to prevent some surgeons from offering the technique to their patients. This underscores the need for effective training methods to ensure that patients will benefit.…”

Section: Training and The Learning Curvementioning

confidence: 99%

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International guidelines for groin hernia management

Simons¹,

Śmietański²,

Bonjer³

et al. 2018

Hernia

1,469

712

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IntroductionWorldwide, more than 20 million patients undergo groin hernia repair annually. The many different approaches, treatment indications and a significant array of techniques for groin hernia repair warrant guidelines to standardize care, minimize complications, and improve results. The main goal of these guidelines is to improve patient outcomes, specifically to decrease recurrence rates and reduce chronic pain, the most frequent problems following groin hernia repair. They have been endorsed by all five continental hernia societies, the International Endo Hernia Society and the European Association for Endoscopic Surgery.MethodsAn expert group of international surgeons (the HerniaSurge Group) and one anesthesiologist pain expert was formed. The group consisted of members from all continents with specific experience in hernia-related research. Care was taken to include surgeons who perform different types of repair and had preferably performed research on groin hernia surgery. During the Group’s first meeting, evidence-based medicine (EBM) training occurred and 166 key questions (KQ) were formulated. EBM rules were followed in complete literature searches (including a complete search by The Dutch Cochrane database) to January 1, 2015 and to July 1, 2015 for level 1 publications. The articles were scored by teams of two or three according to Oxford, SIGN and Grade methodologies. During five 2-day meetings, results were discussed with the working group members leading to 136 statements and 88 recommendations. Recommendations were graded as “strong” (recommendations) or “weak” (suggestions) and by consensus in some cases upgraded. In the Results and summary section below, the term “should” refers to a recommendation. The AGREE II instrument was used to validate the guidelines. An external review was performed by three international experts. They recommended the guidelines with high scores.Results and summaryThe risk factors for inguinal hernia (IH) include: family history, previous contra-lateral hernia, male gender, age, abnormal collagen metabolism, prostatectomy, and low body mass index. Peri-operative risk factors for recurrence include poor surgical techniques, low surgical volumes, surgical inexperience and local anesthesia. These should be considered when treating IH patients. IH diagnosis can be confirmed by physical examination alone in the vast majority of patients with appropriate signs and symptoms. Rarely, ultrasound is necessary. Less commonly still, a dynamic MRI or CT scan or herniography may be needed. The EHS classification system is suggested to stratify IH patients for tailored treatment, research and audit. Symptomatic groin hernias should be treated surgically. Asymptomatic or minimally symptomatic male IH patients may be managed with “watchful waiting” since their risk of hernia-related emergencies is low. The majority of these individuals will eventually require surgery; therefore, surgical risks and the watchful waiting strategy should be discussed with patients. Surgical treatment s...

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Section: Training and The Learning Curvementioning

confidence: 99%

“…This underscores the need for effective training methods to ensure that patients will benefit. 36 , 37 …”

Section: Training and The Learning Curvementioning

confidence: 99%

International guidelines for groin hernia management

Simons¹,

Śmietański²,

Bonjer³

et al. 2018

Hernia

1,469

712

View full text Add to dashboard Cite

show abstract

“…Surveys that have a large sample size perhaps can still credibly be considered in instances where the RR cannot be determined. Trevisonno et al . (Table ) distributed a survey with 903 multinational respondents, but could not state an RR.…”

Section: The Plight Of Surgical Surveysmentioning

confidence: 99%

Surveys still teach vital non‐technical lessons in General Surgery

Hamilton

Young

2018

ANZ Journal of Surgery

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In general surgery, observational studies are disregarded and often seen as non-noteworthy research. We intend to defend the use of surveys in general surgery and colorectal surgery. This review highlights the historical importance and contemporary utility of surveys internationally and in our region, thus reminding Australasian surgeons and clinicians in numerous disciplines of the usefulness of this research tool. Well-constructed surveys often successfully capture qualitative data otherwise impossible to collect through randomized controlled trial. The results of these surveys may advise national policies and medical registration agencies thus having a direct influence on individuals and their public health. Samples from contemporary survey-based research publications from international and Australasian authors are used to illustrate some of the vital non-technical lessons learned in recent times. © 2018 Royal Australasian College of Surgeons ANZ J Surg 89 (2019) 159-164ANZJSurg.com

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“…Laparoscopic inguinal hernia repair (LIHR) is currently not widely accepted among surgeons. [2] Most surgeons prefer to pursue their knowledge and skills gained in the first years of education in this regard. [3] Undoubt-edly the greatest help in developing and implementing techniques is guidelines.…”

Section: Introductionmentioning

confidence: 99%

Learning curve for unilateral endoscopic totally extraperitoneal (TEP) inguinal hernioplasty in a teaching hospital

Ağca¹

2018

Laparosc Endosc Surg Sci

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Introduction: The present study is a description of the learning curve experienced and the process implemented to incorporate the increasingly common laparoendoscopic technique of totally extraperitoneal (TEP) inguinal hernia repair at our clinic. Materials and Methods: Patients with a primary unilateral inguinal hernia who underwent laparoscopic TEP repair between May 2013 and May 2018 were included in the study. The patients were separated into 7 groups. The learning curve parameters (duration of operation, rate of conversion to open surgery, intraoperative and postoperative complications) were recorded and statistically compared. Results: Of the 380 patients, 349 were male and 31 were female, and the mean age was 52±14.2 years. The mean duration of the operation was 46±25.9 minutes. There was a statistically significant difference between the groups in terms of surgical time. The duration of the operation plateaued at <1 hour after 60 surgeries. There was no statistically significant difference between the last 2 groups in terms of the duration of the operation. A total of 7 patients were converted to open surgery. There was no difference between groups in terms of the duration of hospitalization. The average follow-up period was 18 months (range: 3-63 months). Seroma and hematoma occurred in 3 patients and hernia recurrence was observed in 4 patients. Conclusion: It was concluded that a surgeon who has already performed a certain number of inguinal hernia operations can complete the learning curve for TEP repair after 60 operations when the appropriate technical conditions are provided, and that subsequent surgeries can be performed in an optimal time with low complication and recurrence rates.

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A survey of general surgeons regarding laparoscopic inguinal hernia repair: practice patterns, barriers, and educational needs

Cited by 64 publications

References 19 publications

International guidelines for groin hernia management

International guidelines for groin hernia management

Surveys still teach vital non‐technical lessons in General Surgery

Learning curve for unilateral endoscopic totally extraperitoneal (TEP) inguinal hernioplasty in a teaching hospital

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