Murat Ferhat FERHATOĞLU, Abdulcabbar KARTAL, Abut KEBUDİ, Alp GÜRKAN, Ali İlker FİLİZ, Taner KIVILCIM

General surgeons’ approach to laparoscopic inguinal hernia surgery and training expectations in Turkey: A webbased survey

Aim: In this study, we aimed to determine the approach of general surgeons toward laparoscopic inguinal hernia surgery and trainingneeds of surgeons and to collate data that will help formation of training programs or the development of current training programs.Material and Methods: A survey study was designed with 15 questions, including questions regarding determination of characteristicsof their trainings, surgical preferences, and their knowledge and approach toward laparoscopic inguinal hernia surgery. Generalsurgeons in Turkey invited to study on a voluntary basis by using Turkish Surgical Association’s official website.Results: A total of 160 surveys were completed included to the study. Of the total participants, 54.4% included laparoscopic herniasurgery in their daily applications. It was observed that most prevalently used surgical method (60.9%) was total extraperitonealapproach. Of 73 participants, 39 (52.8%) who did not include laparoscopic inguinal hernia surgery into daily surgical proceduresstated that they inform the patients about laparoscopic inguinal hernia surgery during the pre-operative evaluation. The rate ofperforming laparoscopic inguinal hernia surgery was found to be lower among those who had been working for ≥10 years (p = 0.001).Moreover, it was observed that only 18 (34.6%) of the 52 participants, who had been working for ≥10 years and who did not includelaparoscopic hernia repair into their daily surgical procedures, wanted to receive training.Conclusion: General surgeons have a difference of opinion on the benefits of laparoscopic inguinal hernia repair. It is necessary todetermine the obstacles for laparoscopic inguinal hernia surgery to be performed prevalently. Academic institutions designing andbringing the training programs into action can help inform surgeons who want and need the trainings, and success can be obtainedin shortening the time the learning curve takes and lowering of the recurrence and complication rates by continuous medical trainingprograms conducted routinely.

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1. Morales-Conde S, Socas M, Fingerhut A. Endoscopic surgeons’ preferences for inguinal hernia repair: TEP, TAPP, or OPEN. Surg Endosc 2012;26:2639-43.
2. Simons MP, Aufenacker T, Bay-Nielsen M, et al. European hernia society guidelines on the treatment of inguinal hernia in adult patients. Hernia 2009;13:343-403.
3. Rutkow IM. Demo Figureic and socioeconomic aspects of hernia repair in the United States in 2003. Surg Clin North Am 2003;83:1045-51.
4. Smink DS, Paquette IM, Finlayson SR. Utilization of laparoscopic and open inguinal hernia repair: a populationbased analysis. J Laparoendosc Adv Surg Tech 2009;9:745- 8.
5. Lau H, Patil NG, Yuen WK. Learning curve for unilateral endoscopic totally extraperitoneal (TEP) inguinal hernioplasty. Surg Endosc 2002;16:1724-8.
6. Bansal VK, Krishna A, Misra MC, et al. learning curve in laparoscopic inguinal hernia repair: experience at a tertiary care centre. Indian J Surg 2016;78:197-202.
7. McCormack K, Wake B, Perez J, et al. Laparoscopic surgery for inguinal hernia repair: systematic review of effectiveness and economic evaluation. Health Technol Assess 2005;9:1- 203.
8. Neumayer L, Giobbie-Hurder A, Jonasson O, et al. Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 2004;350:1819-27.
9. Rosenberg J, Bay-Nielsen M. Current status of laparoscopic inguinal hernia repair in Denmark. Hernia 2008;12:583-7.
10. Yang C, Zhang H, Pu J, et al. Laparoscopic vs open herniorrhaphy in the management of pediatric inguinal hernias: A systemic review and meta-analysis. J Pediatr Surg 2011;46:1824-34.
11. Wang F, Liu S, Shen Y, et al. A comparative study of the singlesite laparoscopic herniorrhaphy using needle instruments and double site laparoscopic herniorrhaphy in the minimally invasive treatment of inguinal hernias in children. Exp Ther Med 2018;15:2896-900.
12. Mahon D, Decadt B, Rhodes M. Prospective randomized trial of laparoscopic (transabdominal preperitoneal) vs open (mesh) repair for bilateral and recurrent inguinal hernia. Surg Endosc 2003;17:1386-90.
13. Pisanu A, Podda M, Saba A, et al. Meta-analysis and review of prospective randomized trials comparing laparoscopic and Lichtenstein techniques in recurrent inguinal hernia repair. Hernia 2015;19:355-66.
14. Watkins JR, Pryor AD, Truitt MS, et al. Perception versus reality: elucidating motivation and expectations of current fellowship council minimally invasive surgery fellows. Surg Endosc. 2018;32:4422-27.
15. Retrosi G, Morris M, McGavock J. Does personal learning style predict the ability to learn laparoscopic surgery? A pilot study. J Laparoendosc Adv Surg Tech A 2019;29:98-102.
16. Hedrick T, Turrentine F, Sanfey H, et al. Implications of laparoscopy on surgery residency training. Am J Surg 2009;197:73-5.
17. Trvissonno M, Kaneva P, Watanabe Y, et al. A survey of general surgeons regarding laparoscopic inguinal hernia repair: practice patterns, barriers, and educational needs. Hernia 2015;19:719-24.
18. Alkhoury F, Martin JT, Contessa J, et al. The impact of laparoscopy on the volume of open cases in general surgery training. J Surg Educ 2010;67:316-9.
19. Onitsuka A, Katagiri Y, Kiyama S, et al. Current practices in adult groin hernias: a survey of Japanese general surgeons. Surg Today 2003;33:155-7.
20. Sanjay P, Woodward A. A survey of inguinal hernia repair in Wales with special emphasis on laparoscopic repair. Hernia 2007;11:403-7.
21. Society of American Gastrointestinal Endoscopic Surgeons (SAGES) Integrating advanced laparoscopy into surgical residency training. Surg Endosc 1998;12:374–6.
22. Zendejas B, Cook DA, Bingener J, et al. Simulation-based mastery learning improves patient outcomes in laparoscopic inguinal hernia repair: a randomized controlled trial. Ann Surg 2011;254:502-9.