Clinical Outcomes and Learning Curve of Trainee-Performed Laparoscopic Percutaneous Extraperitoneal Closure for Pediatric Inguinal Hernia

Abstract

Background:

Laparoscopic percutaneous extraperitoneal closure (LPEC) for inguinal hernia (IH) in children is an essential technique in surgical training for pediatric surgery in Japan. However, reports on the clinical outcomes and learning curve of trainee-performed LPEC are limited. This study aimed to clarify the clinical outcome and learning curve of LPEC for IH in children, with procedures performed by trainees.

Methods:

This single-center retrospective study included children aged <16 years who underwent LPEC for IH between September 2015 and August 2023. Operative variables, intraoperative and postoperative complications, hernia recurrence, and contralateral metachronous IH (CMIH) were compared among three groups based on surgical experience (trainees with <1 year of experience, trainees with >1 year of experience, and attending pediatric surgeons). The learning curve of trainees with <1 year of experience was analyzed using the cumulative sum method.

Results:

A total of 333 patients were eligible, and trainees with <1 year and >1 year of experience performed 127 (38.1%) and 75 (22.5%) cases of LPEC, respectively. Intraoperative and postoperative complication rates were comparable between trainees with <1 year and >1 year of experience and attending pediatric surgeons (0.0%, 0.0% versus 0.8%, P = .46; 6.3%, 4.0% versus 7.6%, P = .59). Hernia recurrence and CMIH were not observed in all cases. The learning curve analysis indicated that a median of 26 (range, 20–54) procedures were required to achieve the mean pneumoperitoneum time of the attending pediatric surgeons.

Conclusions:

Trainee-performed LPEC was not associated with inferior clinical outcomes. At least 55 procedures are necessary for all trainees to become proficient in LPEC.