Outcomes of a structured training programme for paediatric laparoscopic inguinal hernia repair

IntroductionA structured training programme for laparoscopic paediatric inguinal hernia (LPIH) repair was devised. This programme was evaluated to ensure patient safety by assessing long-term outcomes of operated patients.MethodTraining Programme — Trainees undergo at least monthly consultant-supervised simulation sessions using the LPIH model. They then undertake live-operating in a step-wise progression: (A) laparoscopic ports insertion and wound closure, (B) intra-corporeal knot tying, and (C) purse-string suturing of hernial orifice.Study — All patients undergoing LPIH repair from July 2003 to Sept 2011 were analysed. Trainee involvement was recorded prospectively, and patients were classified: Group 1 — Consultant only; Group 2 — Trainee performed step A; Group 3 — Trainee performed steps A & B; Group 4 — Trainee performed all steps.Results224 patients were identified (175 male; 49 female). Average age at surgery was 2.2 years [range: premature (35/40 weeks) to 15 years]. The laterality of the inguinal hernia was: right (n = 133), left (n = 75), bilateral (n = 16). Primary operator was defined as Group 1 n = 88 (39%), Group 2 n = 25 (12%), Group 3 n = 57 (25%), and Group 4 n = 54 (24%). Hernia recurrence occurred in 2 (1.8%) children where consultant operated and two (1.8%) where a trainee operated. Post-operative groin swelling (resolved spontaneously) occurred in 2 (1.8%) where consultant operated and 2 (1.8%) of the trainee cases. There were 3 children with iatrogenic post-operative cryptorchidism requiring subsequent orchidopexy, all from Group 3.ConclusionThis study shows that comparable outcomes can be achieved with a structured training programme for LPIH repair for trainees. The exception appears to be iatrogenic cryptorchidism that only occurred in trainee Group 3.