[Surgeons learn how to learn. Study of 76,499 herniorrhaphies performed between 1993 and 1997 registered by the chamber of physicians in Westfalia-Lippe].
BACKGROUND
New techniques require "new" surgeons who are able to apply them safely. The bushfire-like employment of laparoscopic cholecystectomy confronted a community of surgeons totally inexperienced in that technique. Thus, the collective learning curve was paralleled by a temporary increase of postoperative complications. The aim of the following study was to analyze the learning curve for laparoscopic herniorrhaphy with regard to the complication rates during that period.


METHODS
A total of 76,499 questionnaires from the external quality assurance of the Westfalia-Lippe physicians board registered between 1993 and 1997 were analyzed retrospectively. The parameters (duration of the operation and hospitalization, ASA classification, rate of obese patients, intra- and postoperative complications) were analyzed and plotted as a synchronized learning curve of the whole group of surgeons.


RESULTS
As for laparoscopic cholecystectomy, a learning curve was found for laparoscopic herniorrhaphy, which could be attributed to a decreasing duration of the procedures and increasing ASA classification and rate of morbid obese patients while complication rates were kept constantly low. After 9 months of application laparoscopic hernia repair seemed to have been introduced to a new collective of surgeons while learning parameters showed inverse trends for a short period of time. The complication rate of laparoscopic hernia repair was constantly lower than in routine open inguinal hernia repair.


CONCLUSIONS
Since laparoscopic inguinal hernia repair is a demanding method, surgeons apparently did not forget the lessons learned from the introduction of laparoscopic cholecystectomy as they were able to avoid increasing intra- and postoperative complication rates during their learning curve. Surgeons are learning to learn.
Chirurgische Klinik, Evangelisches Krankenhaus, Hattingen.
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N
Wojtyczka
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MN
Wente
M
M
Wenning
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J
Kozianka
H
H
Waleczek
D000293:Adolescent; D000328:Adult; D000368:Aged; D002983:Clinical Competence / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003479:Curriculum / Q000639:trends; D003627:Data Interpretation, Statistical; D004502:Education, Medical, Continuing / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D005544:Forecasting; D013502:General Surgery / Q000193:education*; D005858:Germany; D006552:Hernia, Inguinal / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000639:trends*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000706:statistics & numerical data