Trends in minimally invasive and open inguinal hernia repair: an analysis of ACGME general surgery case logs

Authors

Alex I. Halpern, Department of Surgery, George Washington University School of Medicine & Health Sciences, 2150 Pennsylvania Ave NW, Suite 6B, Washington, DC, 20037, USA. alexhalpern@gwu.edu.
Margaret Klein, Department of Surgery, George Washington University School of Medicine & Health Sciences, 2150 Pennsylvania Ave NW, Suite 6B, Washington, DC, 20037, USA.
Benjamin McSweeney, Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Hoang-Viet Tran, Department of Surgery, George Washington University School of Medicine & Health Sciences, 2150 Pennsylvania Ave NW, Suite 6B, Washington, DC, 20037, USA.
Sangrag Ganguli, Department of Surgery, University of Chicago, Chicago, IL, USA.
Victoria Haney, Department of Surgery, George Washington University School of Medicine & Health Sciences, 2150 Pennsylvania Ave NW, Suite 6B, Washington, DC, 20037, USA.
Salem I. Noureldine, Department of Surgery, George Washington University School of Medicine & Health Sciences, 2150 Pennsylvania Ave NW, Suite 6B, Washington, DC, 20037, USA.
Khashayar Vaziri, Department of Surgery, George Washington University School of Medicine & Health Sciences, 2150 Pennsylvania Ave NW, Suite 6B, Washington, DC, 20037, USA.
Hope T. Jackson, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
Juliet Lee, Department of Surgery, George Washington University School of Medicine & Health Sciences, 2150 Pennsylvania Ave NW, Suite 6B, Washington, DC, 20037, USA.

Document Type

Journal Article

Publication Date

4-17-2024

Journal

Surgical endoscopy

DOI

10.1007/s00464-024-10805-y

Keywords

ACGME case log; Femoral hernia; Inguinal hernia; Minimally invasive; Open; Surgical education

Abstract

BACKGROUND: Groin hernia repair is one of the most commonly performed surgical procedures and is often performed by surgical interns and junior residents. While traditionally performed open, minimally invasive (MIS) groin hernia repair has become an increasingly popular approach. The purpose of this study was to determine the trends in MIS and open inguinal and femoral hernia repair in general surgery residency training over the past two decades. METHODS: Accreditation Council for Graduate Medical Education (ACGME) national case log data of general surgery residents from 1999 through 2022 were reviewed. We collected means and standard deviations of open and MIS inguinal and femoral hernia repairs. Linear regression and ANOVA were used to identify trends in the average annual number of open and MIS hernia repairs logged by residents. Cases were distinguished between level of resident trainees: surgeon-chief (SC) and surgeon-junior (SJ). RESULTS: From July 1999 to June 2022, the average annual MIS inguinal and femoral hernia repairs logged by general surgery residents significantly increased, from 7.6 to 47.9 cases (p < 0.001), and the average annual open inguinal and femoral hernia repairs logged by general surgery residents significantly decreased, from 51.9 to 39.7 cases (p < 0.001). SJ resident results were consistent with this overall trend. For SC residents, the volume of both MIS and open hernia repairs significantly increased (p < 0.001). CONCLUSIONS: ACGME case log data indicates a trend of general surgery residents logging overall fewer numbers of open inguinal and femoral hernia repairs, and a larger proportion of open repairs by chief residents. This trend warrants attention and further study as it may represent a skill or knowledge gap with significant impact of surgical training.

APA Citation

Halpern, Alex I.; Klein, Margaret; McSweeney, Benjamin; Tran, Hoang-Viet; Ganguli, Sangrag; Haney, Victoria; Noureldine, Salem I.; Vaziri, Khashayar; Jackson, Hope T.; and Lee, Juliet, "Trends in minimally invasive and open inguinal hernia repair: an analysis of ACGME general surgery case logs" (2024). GW Authored Works. Paper 4714.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4714

Department

Surgery