title: Day case laparoscopic herniorraphy. A NICE procedure with a long learning curve.
abstract: BACKGROUND
  The aim of this study was to evaluate day case laparoscopic herniorraphy (LH) and to ascertain the impact of trainee surgeons on its performance.
  
  
  METHODS
  We performed a prospective study of ambulatory laparoscopic transabdominal preperitoneal herniorraphies performed in a dedicated day surgical unit between March 1996 and October 2003.
  
  
  RESULTS
  A total of 840 herniorraphies were performed in 706 consecutive patients. Surgery was performed by 15 higher surgical trainees and three consultant surgeons. The mean operating times for trainees were longer for unilateral (48.4 +/- 0.98 vs 41.4 +/- 0.87 min, p < 0.05) and bilateral (69.0 +/- 3.24 vs 53.0 +/- 1.68 min, p < 0.05) repairs than for consultants. Subgroup analysis demonstrated that after an experience of 40 procedures, trainee times approached those of the consultants (41.39 +/- 1.17 vs 41.4 +/- 0.87 min, p= 0.31). LH repair was well tolerated and associated with minimal postoperative pain and nausea. Mean pain scores postoperatively and at 24 h were 2.69 +/- 0.11 and 2.07 +/- 0.09, respectively. Mean nausea scores postoperatively and at 24 h were 0.34 +/- 0.06 and 0.22 +/- 0.06, respectively. Ninety-three percent of patients (n = 657) were discharged within 8 h. There were two conversions to an open procedure (0.1%) and two significant complications (0.1%). Ninety-five percent of patients who responded to our questionnaire (n = 398/419) were satisfied with surgery and would undergo day case laparoscopic herniorraphy again.
  
  
  CONCLUSIONS
  Laparoscopic herniorraphy is a safe technique suitable for day case surgery. Operator experience dictates duration of surgery. Trainees' operating times approach those of consultants after 40 procedures. Prolonged operating times and increased cost are not justifiable reasons for not recommending LH.
authors.affiliation: Division of Oesophagogastric and Minimally Invasive Surgery, Hull Royal Infirmary, Anlaby Road, Kingston upon Hull, HU3 2JZ, UK.
authors.forename: M
authors.initials: M
authors.lastname: Lim
authors.forename: C J
authors.initials: CJ
authors.lastname: O'Boyle
authors.forename: C M S
authors.initials: CM
authors.lastname: Royston
authors.forename: P C
authors.initials: PC
authors.lastname: Sedman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D002983:Clinical Competence; D004501:Education, Medical; D004502:Education, Medical, Continuing; D005260:Female; D046449:Hernia, Abdominal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007858:Learning; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D009325:Nausea / Q000209:etiology; D010149:Postoperative Pain / Q000503:physiopathology; D017060:Patient Satisfaction; D013514:Surgical Procedures, Operative / Q000193:education*; D013997:Time Factors; D006113:United Kingdom