Surgeon Volume and Risk of Reoperation after Laparoscopic Primary Ventral Hernia Repair: A Nationwide Register-Based Study

Christophersen, Camilla; Fonnes, Siv; Baker, Jason Joe; Andresen, Kristoffer; Rosenberg, Jacob

doi:10.1016/j.jamcollsurg.2021.05.023

Cited by 5 publications

(7 citation statements)

References 23 publications

(30 reference statements)

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“…The EBS has defined eligibility requirements for UEMS AWS qualification which can be found on the UEMS website. 1 A total combined number of 800 credits points have to be acquired which correlates with about 200 inguinal hernia repairs, 50 primary ventral hernia repairs and 50 incisional and complex hernia repairs, in addition to 200 CME points from training courses.…”

Section: The Traineementioning

confidence: 99%

Description of the Current Da Vinci® Training Pathway for Robotic Abdominal Wall Surgery by the European Hernia Society

Vierstraete¹,

Simons²,

Borch³

et al. 2022

J. Abdom. Wall Surg.

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Background: Robot assisted laparoscopic abdominal wall surgery (RAWS) has seen a rapid adoption in recent years. The safe introduction of the robot platform in the treatment of abdominal wall hernias is important to safeguard the patient from harm during the learning curve. The scope of this paper is to describe the current European training curriculum in RAWS.Methods and Analysis: The pathway to competence in RAWS will depend on the robot platform, experience in other abdominal procedures (novice to expert) and experience in the abdominal wall repair techniques. An overview of the learning curve effect in the initial case series of several early adopters in RAWS was reviewed. In European centres, current training for surgeons wanting to adopt RAWS is managed by the specific technology-based training organized by the company providing the robot. It consists of four phases where phases I and II are preclinical, while phases III and IV focus on the introduction of the robotic platform into surgical practice.Conclusion: On behalf of the Robotic Surgery Task Force of the European Hernia Society (EHS) we believe that the EHS should play an important role in the clinical phases III and IV training. Courses organized in collaboration with the robot provider on relevant surgical anatomy of the abdominal wall and procedural steps in complex abdominal wall reconstruction like transversus abdominis release are essential. Whereas the robot provider should be responsible for the preclinical phases I and II to gain familiarity in the specific robot platform.

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Section: The Traineementioning

confidence: 99%

Description of the Current Da Vinci® Training Pathway for Robotic Abdominal Wall Surgery by the European Hernia Society

Vierstraete¹,

Simons²,

Borch³

et al. 2022

J. Abdom. Wall Surg.

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“…Résultats : Nous avons inclus 94 patients qui, après répartition aléatoire, ont subi une reconstruction avec 1 des 2 treillis biologiques couramment utilisés ici à l'étude (âge moyen 59,4 ans, écart-type [É.-T.] 9,9, proportion de femmes 51 %, indice de masse corporelle 32,9, É.-T. 6,8). Nous n'avons observé aucune différence significative entre les groupes (comorbidité, facteurs de risque de récidive de la hernie, taille de la hernie ou profil infectieux).…”

Section: Contexteunclassified

“…7 Careful patient selection, prehabilitation, precise surgical technique and selecting the optimal procedure from a wide variety of available options (i.e., addressing patient anatomy and the quality of the abdominal wall componentry) are critical to ensure a durable repair. 8 In a clean operation without bacterial contamination, a permanent synthetic mesh is typically employed as a reinforcement to lower the risk of recurrence (i.e., by 50%). [9][10][11] This technique has represented the standard of care for decades.…”

Section: Contextementioning

confidence: 99%

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Is the type of biomesh relevant in the prevention of recurrence following abdominal wall reconstruction? A randomized controlled trial

Ball

Kirkpatrick

Stuleanu

et al. 2022

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Background: Complex abdominal wall reconstruction technique remains controversial. The use of biologic mesh products is also debated in active infection, sepsis prophylaxis and high-risk patients. Differences in biologic mesh technology and cost remain significant. We aimed to compare the efficacy of 2 commonly used biologic meshes in regards to hernia recurrence at 1 year. Methods: This study was a parallel, dual-arm, double-blind randomized controlled trial involving adult patients undergoing complex abdominal wall reconstruction with a biologic mesh at a quaternary care institution (2017–2020). Patients were randomly assigned to receive Permacol (cross-linked) compared with Strattice (not crosslinked). The main outcome measure was hernia recurrence at 1 or more years following the index repair. Results: We included 94 patients randomized to undergo reconstruction with 1 of 2 commonly used biologic mesh products (mean age 59.4 yr, standard deviation [SD] 9.9; 51% female; body mass index 32.9, SD 6.8). We found no significant differences between the groups (patient comorbidities, hernia recurrence risk factors, hernia size or infection profiles). Hernia recurrence rates (15%) were similar between groups (median 783 days of follow up, interquartile range 119). We found there was significantly less of a need for a component separation technique in the Strattice group (69% v. 87%). All other secondary outcome measures were equivalent between study arms. Multivariate analysis identified hepatic transplantation (odds ratio [OR] 1.94, 95% confidence intervals [CI] 0.33–4.41), active abdominal wall infection (OR 2.01, 95% CI 0.50–7.01), and more than 1 previous hernia repair (OR 2.68, 95% CI 0.41–5.99) as risk factors for subsequent hernia recurrence; however, there was no difference in recurrence factors between patient study groups. Conclusion: Given similar clinical performance between the 2 most commonly used biologic mesh products, the most cost effective mesh should be used in cost-conscious health care systems.

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“…Annual surgeon volume has been shown to be associated with the quality of hernia repair, and low-volume surgeons have been associated with higher risks of reoperation after repair of primary groin and ventral hernia repair. 1,2 Furthermore, studies by our group 1,2 have previously shown in the Danish Inguinal and Ventral Hernia Databases (hereinafter, the Danish Hernia Databases) that lowvolume surgeons were, for the most part, inexperienced or still in their general surgery residency. Hernia repair is a part of the general surgery training curriculum in many countries since it is a common procedure worldwide.…”

mentioning

confidence: 99%

Risk of Reoperation for Recurrence After Elective Primary Groin and Ventral Hernia Repair by Supervised Residents

et al. 2023

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ImportanceSurgical training involves letting residents operate under supervision. Since hernia repair is a common procedure worldwide, it is a frequent part of the surgical curriculum.ObjectiveTo assess the risk of reoperation for recurrence after elective primary groin and ventral hernia repair performed by supervised residents compared with that by specialists.Design, Setting, and ParticipantsThis nationwide register-based cohort study included data from January 2016 to September 2021. Patients were followed up until reoperation, emigration, death, or the end of the study period. The study used data from the Danish Inguinal and Ventral Hernia Databases linked with data from the Danish Patient Safety Authority’s Online Register via surgeons’ unique authorization ID.The cohort included patients aged 18 years or older who underwent primary elective hernia repairs performed by supervised residents or specialists for inguinal, femoral, epigastric, or umbilical hernias. Hernia repairs were divided into the following 4 groups: Lichtenstein groin, laparoscopic transabdominal preperitoneal (TAPP) groin, open ventral, and laparoscopic ventral.ExposuresHernia repairs performed by supervised residents vs specialists.Main Outcomes and MeasuresReoperation for recurrence, analyzed separately for all 4 groups.ResultsA total of 868 specialists and residents who performed 31 683 primary groin and 7777 primary ventral hernia repairs were included in this study. The median age of patients who underwent hernia repair was 60 years (IQR, 48-70 years), and 33 424 patients (84.7%) were male. There was no significant difference in the adjusted risk of reoperation after Lichtenstein groin hernia repair (hazard ratio [HR], 1.26; 95% CI, 0.99-1.59), laparoscopic groin hernia repair (HR, 1.01; 95% CI, 0.73-1.40), open ventral hernia repair (HR, 0.89; 95% CI, 0.61-1.29), and laparoscopic ventral hernia repair (HR, 2.96; 95% CI, 0.99-8.84) performed by supervised residents compared with those by specialists. There was, however, a slightly increased unadjusted, cumulative reoperation rate after Lichtenstein repairs performed by supervised residents compared with those by specialists (4.8% vs 4.2%; P = .048).Conclusions and RelevanceThe findings of this study suggest that neither open nor laparoscopic repair of groin and ventral hernias performed by supervised residents appeared to be associated with a higher risk of reoperation for recurrence compared with the operations performed by specialists. This indicates that residents may safely perform elective hernia repair when supervised as part of their training curriculum.

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Surgeon Volume and Risk of Reoperation after Laparoscopic Primary Ventral Hernia Repair: A Nationwide Register-Based Study

Cited by 5 publications

References 23 publications

Description of the Current Da Vinci® Training Pathway for Robotic Abdominal Wall Surgery by the European Hernia Society

Description of the Current Da Vinci® Training Pathway for Robotic Abdominal Wall Surgery by the European Hernia Society

Is the type of biomesh relevant in the prevention of recurrence following abdominal wall reconstruction? A randomized controlled trial

Risk of Reoperation for Recurrence After Elective Primary Groin and Ventral Hernia Repair by Supervised Residents

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