J Minim Invasive Surg.  2024 Jun;27(2):85-94. 10.7602/jmis.2024.27.2.85.

A retrospective noninferiority study of laparoscopic inguinal hernia repair feasibility for recently graduated surgeons in Thailand

• Tantinam T
• Treeratanawikran T
• Kamoncharoen P
• Srimaneerak E
• Siripoonsap M
• Phoonkaew T

• KMID: 2556652
• DOI: http://doi.org/10.7602/jmis.2024.27.2.85

Abstract

Purpose
The feasibility of starting laparoscopic surgery among newly graduated surgeons lacking extensive experience in open approaches remains a topic of interest. We aimed to evaluate the safety and efficacy of laparoscopic inguinal hernia repair (LHR) compared to open inguinal hernia repair (OHR) in this population.
Methods
This retrospective cohort study was conducted on inguinal hernia surgeries performed by a single recently graduated surgeon during the learning phase. Patient data were collected from July 2021 to November 2022 with a focus on demographics, intraoperative details, and 1-year postoperative outcomes. Noninferiority testing was employed with a predetermined margin of 15% to compare the complication rates, recurrence rates, and other secondary outcomes between LHR and OHR.
Results
The study cohort comprised 66 patients (OHR group, n = 45 and LHR group, n = 21). Patient characteristics were similar between groups. No significant differences were observed in the complication rates (OHR, 26.7% and LHR, 19.0%; p = 0.50) or recurrence rates (OHR, 2.2% and LHR, 4.8%; p = 0.54). The LHR group demonstrated noninferior outcomes compared with the OHR group in terms of complication, recurrence, readmission, and reoperation rates. Except for the operative time, secondary outcomes did not differ significantly between the groups.
Conclusion
LHR is a feasible initiation for recently graduated surgeons, demonstrating noninferior outcomes compared with open repair. Therefore, the belief that one must master open surgery before beginning laparoscopy may be untrue.

Keyword

Laparoscopy; Inguinal hernia; Herniorrhaphy; Learning curve; Surgeons