Giddings Hugh L, Fenton-Lee Douglas
Department of General Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia.
ANZ J Surg. 2021 Jun;91(6):1138-1142. doi: 10.1111/ans.16897. Epub 2021 Apr 27.
There are no publications addressing the level of experience Australian surgical trainees achieve in inguinal hernia surgery. Internationally, some training boards have set minimum competency requirements, but this is not true in Australia. The longer learning curve for laparoscopic inguinal hernia repairs (LIHRs) compared to open inguinal hernia repairs (OIHRs) has placed greater demands on trainees.
Logbook data on OIHR and LIHR for Australian surgical trainees who graduated as fellows between 2013 and 2018 were obtained. A literature review was performed to analyse international published logbook numbers for surgical trainees from the past decade. International training board requirements, estimations of the learning curve and hernia society guidelines for each procedure were reviewed.
In total, 7946 operations were recorded from 58 trainees. On average 49.2 OIHRs (range 13-101), 21.5 LIHRs (range 1-94) and 71.1 inguinal hernia repairs overall (range 25-129) were performed during training. The European Hernia Society recommends that at least 30-50 of each procedure be performed during training. The learning curves for LIHRs (50-100 procedures) have been shown to be longer than for OIHRs (40-64 procedures).
Australian general surgical trainees are achieving adequate primary operator logbook numbers for OIHRs but are not completing the required number of LIHRs. The tailored approach to inguinal hernia repair requires skill in both open and laparoscopic repairs. This may not be possible with the current training structure in Australia.
目前尚无关于澳大利亚外科住院医师腹股沟疝手术经验水平的相关出版物。在国际上，一些培训委员会已设定了最低能力要求，但在澳大利亚并非如此。与开放腹股沟疝修补术（OIHR）相比，腹腔镜腹股沟疝修补术（LIHR）的学习曲线更长，这对住院医师提出了更高要求。
获取了2013年至2018年间毕业成为专科医师的澳大利亚外科住院医师关于OIHR和LIHR的手术记录数据。进行了文献综述，以分析过去十年国际上公布的外科住院医师手术记录数量。审查了国际培训委员会的要求、每种手术学习曲线的估计以及疝学会指南。
共记录了来自58名住院医师的7946例手术。培训期间平均进行49.2例OIHR（范围13 - 101）、21.5例LIHR（范围1 - 94）以及总共71.1例腹股沟疝修补术（范围25 - 129）。欧洲疝学会建议培训期间每种手术至少进行30 - 50例。已表明LIHR的学习曲线（50 - 100例手术）比OIHR的学习曲线（40 - 64例手术）更长。
澳大利亚普通外科住院医师在OIHR方面达到了足够的主刀手术记录数量，但未完成所需的LIHR数量。腹股沟疝修补术的定制方法需要开放和腹腔镜修补两方面的技能。以澳大利亚目前的培训结构可能无法做到这一点。
