Ergül Z, Kulaçoğlu H, Sen T, Esmer A F, Güller M, Güneri G, Elhan A
Department of Surgery, Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey.
Chirurgia (Bucur). 2011 Sep-Oct;106(5):599-603.
Inguinal hernia repair is one of the most common operations in a junior surgical resident's postgraduate training. Short recall courses can improve junior residents' anatomy knowledge and results in better surgical outcomes. We aimed to investigate the effect of a short course on anatomical competency during inguinal hernia repairs.
During the first 25 inguinal hernia repairs, two junior residents were asked to identify iliohypogastric, ilioinguinal, and genital branch of genitofemoral nerves. Then, the residents were given a short recall course by anatomists. Afterwards, the participants were taken into an in-vivo anatomy test again. The same parameters were recorded in another 25 inguinal hernia repairs. In addition to the nerve identification records, case characteristics [body mass index (BMI < or = 25 vs. >25), hernia type (indirect vs. direct), and anesthesia used (general or regional vs. local)] were recorded.
Anatomy education had a clear impact on the correct identification rates for the iliohypogastric and ilioinguinal nerves. The rates increased from 70% to 90% and above. Correct identification rate for the three nerves together significantly increased from 16 to 52% following anatomy education (P = 0.006). All three nerves were identified with significantly higher success rates after anatomy education. The increase in the success rate for identification of the genital branch of genitofemoral nerve was 4-fold.
Short anatomy courses in specific subjects for junior surgical residents given by formal anatomists may be effective during postgraduate education. The benefit obtained in the present study for the inguinal region nerves may be expanded to more important anatomical structures, such as the recurrent laryngeal nerve in a thyroidectomy, or more complex subjects.
腹股沟疝修补术是初级外科住院医师毕业后培训中最常见的手术之一。短期复习课程可提高初级住院医师的解剖学知识，并带来更好的手术效果。我们旨在研究短期课程对腹股沟疝修补术中解剖能力的影响。
在前25例腹股沟疝修补术中，要求两名初级住院医师识别髂腹下神经、髂腹股沟神经和生殖股神经生殖支。然后，解剖学家为住院医师提供了一个短期复习课程。之后，再次对参与者进行活体解剖测试。在另外25例腹股沟疝修补术中记录相同参数。除神经识别记录外，还记录病例特征[体重指数（BMI≤25与＞25）、疝类型（间接与直接）和所用麻醉（全身或区域与局部）]。
解剖学教育对髂腹下神经和髂腹股沟神经的正确识别率有明显影响。识别率从70%提高到90%及以上。解剖学教育后，三条神经的总正确识别率从16%显著提高到52%（P = 0.006）。解剖学教育后，所有三条神经的识别成功率均显著提高。生殖股神经生殖支的识别成功率提高了4倍。
由正规解剖学家为初级外科住院医师开设的特定学科短期解剖学课程在研究生教育期间可能有效。本研究中在腹股沟区神经方面获得的益处可能扩展到更重要的解剖结构，如甲状腺切除术中的喉返神经，或更复杂的学科。
