Postoperative outcomes of inguinal hernia repair performed by surgical residents in routine clinical practice: a retrospective single-center analysis.

Abstract

Objectives: Inguinal hernia repair is one of the most common surgical procedures performed worldwide. As part of training, surgical residents perform these procedures, which raises questions about the safety and efficacy of their involvement compared to specialists. This study compares the postoperative outcome and complications of inguinal hernia repairs conducted by residents under supervision with those performed by board certified surgeons independent of the method of surgery.

Methods: This retrospective cohort study was performed at a single tertiary care center. 388 patients undergoing inguinal hernia repair, aged 18 years and older were included. Data were collected from 2014 to 2020.

Results: The techniques used for the hernia repair were open repair using the Lichtenstein technique (n=159) and the transabdominal preperitoneal (TAPP) mesh technique (n=228). The hernia repairs were mostly performed as an open procedure by residents (n=72; 45 %), whereas board-certified surgeons mostly operated laparoscopically (n=190; 83 %). Surgical trainees had significantly longer operation times when performing a laparoscopic procedure than attending surgeons (means: 94 vs.70 min; p<0.001). However, there was no difference in operation time when an open procedure was performed (p=0.988). Univariate analyses revealed no influence of the level of training on overall postoperative morbidity (p=0.138) but showed that the TAPP technique was a protective factor for postoperative complications (p<0.001).

Conclusions: Resident participation in inguinal hernia repair is safe and does not increase postoperative complications. In the tertiary care center, residents primarily performed open repairs, while board-certified surgeons favored the minimally invasive approach. Both techniques proved to be safe under appropriate supervision. These findings highlight the feasibility of structured surgical training in routine clinical practice, ensuring patient safety while maintaining high educational standards.