The reality of general surgery training and increased complexity of abdominal wall hernia surgery

被引:75
作者
Koeckerling, F. [1 ,2 ]
Sheen, A. J. [3 ]
Berrevoet, F. [4 ]
Campanelli, G. [5 ]
Cuccurullo, D. [6 ]
Fortelny, R. [7 ,8 ]
Friis-Andersen, H. [9 ]
Gillion, J. F. [10 ]
Gorjanc, J. [11 ]
Kopelman, D. [12 ,13 ]
Lopez-Cano, M. [14 ]
Morales-Conde, S. [15 ]
Osterberg, J. [16 ]
Reinpold, W. [17 ]
Simmermacher, R. K. J. [18 ]
Smietanski, M. [19 ,20 ]
Weyhe, D. [21 ]
Simons, M. P. [22 ]
机构
[1] Vivantes Hosp, Charite Med Sch, Acad Teaching Hosp, Dept Surg, Neue Bergstrasse 6, D-13585 Berlin, Germany
[2] Vivantes Hosp, Charite Med Sch, Acad Teaching Hosp, Ctr Minimally Invas Surg, Neue Bergstrasse 6, D-13585 Berlin, Germany
[3] Manchester Univ NHS Fdn Trust, Dept Surg, Manchester M13 9WL, Lancs, England
[4] Univ Ziekenhuis Gent, Dept Gen & HPB Surg & Liver Transplantat, C Heymanslaan 10, B-9000 Ghent, Belgium
[5] Univ Insurbria, Ctr Res & High Specializat Pathol Abdominal Wall, Inst Clin St Ambrogio, Gen & Day Surg Unit,Milano Hernia Ctr, Milan, Italy
[6] AO Colli Monaldi Hosp Naples, Dept Gen Laparoscop & Robot Surg, Chief Week Surg Dept Unit, Naples, Italy
[7] Wilhelminenspital Stadt Wien, Dept Gen Visceral & Oncol Surg, A-1160 Vienna, Austria
[8] Sigmund Freud Univ, Fac Med, A-1020 Vienna, Austria
[9] Aarhus Univ, Horsens Reg Hosp, Dept Surg, Sundvey 30, DK-8700 Horsens, Denmark
[10] Hop Prive Antony, Unite Chirurg Viscerale, 1 Rue Velpeau, F-92160 Antony, France
[11] Krankenhaus Barmherzigen Bruder, Dept Surg, Spitalgasse 26, A-9300 St Veit An Der Glan, Austria
[12] Emek Med Ctr, Dept Surg, Afula, Israel
[13] Technion Israel Inst Technol, Rappaport Fac Med, Haifa, Israel
[14] Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Gen Surg, Abdominal Wall Surg Unit, Passeig Vall dHebron 119-129, Barcelona 08035, Spain
[15] Univ Hosp Virgen del Rocio, Unit Innovat Minimally Invas Surg, Ave Manuel Siurot S-N, Seville 41013, Spain
[16] Mora Hosp, Dept Surg, S-79285 Mora, Sweden
[17] Wilhelmsburger Krankenhaus Gross Sand, Gross Sand 3, D-21107 Hamburg, Germany
[18] Univ Med Ctr Utrecht, Dept Surg, Heidelbergglaan 100, Utrecht, Netherlands
[19] Med Univ Gdansk, Hosp Puck, Dept Gen Surg, Gdansk, Poland
[20] Med Univ Gdansk, Hosp Puck, Hernia Ctr, Gdansk, Poland
[21] Pius Hosp Oldenburg, Univ Hosp Visceral Surg, Sch Med & Hlth Sci, Med Campus Univ Oldenburg,Georgstr 12, D-26121 Oldenburg, Germany
[22] OLVG Hosp, Dept Surg, Amsterdam, Netherlands
关键词
Surgical training; Learning curve; Complex hernias; Tailored approach; Inguinal hernia; Incisional hernia; (INTERNATIONAL ENDOHERNIA SOCIETY; UNILATERAL INGUINAL-HERNIAS; OPERATIVE EXPERIENCE; LAPAROSCOPIC TREATMENT; INCISIONAL HERNIA; RISK-FACTORS; PERIOPERATIVE COMPLICATIONS; EXTERNAL VALIDATION; ENDOSCOPIC REPAIR; AMERICAN-COLLEGE;
D O I
10.1007/s10029-019-02062-z
中图分类号
R61 [外科手术学];
学科分类号
摘要
Introduction The Accreditation and Certification of Hernia Centers and Surgeons (ACCESS) Group of the European Hernia Society (EHS) recognizes that there is a growing need to train specialist abdominal wall surgeons. The most important and relevant argument for this proposal and statement is the growing acceptance of the increasing complexity of abdominal wall surgery due to newer techniques, more challenging cases and the required 'tailored' approach to such surgery. There is now also an increasing public awareness with social media, whereby optimal treatment results are demanded by patients. However, to date the complexity of abdominal wall surgery has not been properly or adequately defined in the current literature. Methods A systematic search of the available literature was performed in May 2019 using Medline, PubMed, Scopus, Embase, Springer Link, and the Cochrane Library, with 75 publications identified as relevant. In addition, an analysis of data from the Herniamed Hernia Registry was performed. The percentage of patients with hernia- or patient-related characteristics which unfavorably impacted the outcome of inguinal and incisional hernia repair was also calculated. Results All present guidelines for abdominal wall surgery recommend the utilization of a 'tailored' approach. This relies on the prerequisite that any surgical technique used has already been mastered, as well as the recognized learning curves for each of the several techniques that can be used for both inguinal hernia (Lichtenstein, TEP, TAPP, Shouldice) and incisional hernia repairs (laparoscopic IPOM, open sublay, open IPOM, open onlay, open or endoscopic component separation technique). Other hernia- and patient-related characteristics that have recognized complexity include emergency surgery, obesity, recurrent hernias, bilateral inguinal hernias, groin hernia in women, scrotal hernias, large defects, high ASA scores, > 80 years of age, increased medical risk factors and previous lower abdominal surgery. The proportion of patients with at least one of these characteristics in the Herniamed Hernia Registry in the case of both inguinal and incisional hernia is noted to be relatively high at around 70%. In general surgery training approximately 50-100 hernia repairs on average are performed by each trainee, with around only 25 laparo-endoscopic procedures. Conclusion A tailored approach is now employed and seen more so in hernia surgery and this fact is referred to and highlighted in the contemporaneous hernia guidelines published to date. In addition, with the increasing complexity of abdominal wall surgery, the number of procedures actually performed by trainees is no longer considered adequate to overcome any recognized learning curve. Therefore, to supplement general surgery training young surgeons should be offered a clinical fellowship to obtain an additional qualification as an abdominal wall surgeon and thus improve their clinical and operative experience under supervision in this field. Practicing general surgeons with a special interest in hernia surgery can undertake intensive further training in this area by participating in clinical work shadowing in hernia centers, workshops and congresses.
引用
收藏
页码:1081 / 1091
页数:11
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