title: Total Extraperitoneal Hernia Repair: Residency Teaching Program and Outcome Evaluation.
abstract: Total extraperitoneal (TEP) hernia repair has been shown to offer less pain, shorter postoperative hospital stay and earlier return to work when compared to open surgery. Our institution routinely performs TEP procedures for patients with primary or recurrent inguinal hernias. The aim of this study was to show that supervised senior residents can safely perform TEP repairs in a teaching setting.
  
  
  
  All consecutive patients treated for inguinal hernias by laparoscopic approach from October 2008 to June 2012 were retrospectively analyzed from a prospective database.
  
  
  
  A total of 219 TEP repairs were performed on 171 patients: 123 unilateral and 48 bilateral. The mean patient age was 51.6 years with a standard deviation (SD) of ± 15.9. Supervised senior residents performed 171 (78 %) and staff surgeons 48 (22 %) TEP repairs, respectively. Thirty-day morbidity included cases of inguinal paresthesias (0.4 %, n = 1), umbilical hematomas (0.9 %, n = 2), superficial wound infections (0.9 %, n = 2), scrotal hematomas (2.7 %, n = 6), postoperative urinary retentions (2.7 %, n = 6), chronic pain syndromes (5 %, n = 11) and postoperative seromas (6.7 %, n = 14). Overall, complication rates were 18.7 % for staff surgeons and 19.3 % for residents (p = 0.83). For staff surgeons and residents, mean operative times for unilateral hernia repairs were 65 min (SD ± 18.9) and 77.6 min (SD ± 29.8) (p = 0.043), respectively, while mean operative times for bilateral repairs were 115 min (SD ± 40.1) and 103.6 (SD ± 25.9) (p = 0.05).
  
  
  
  TEP repair is a safe procedure when performed by supervised senior surgical trainees. Teaching of TEP should be routinely included in general surgery residency programs.
authors.affiliation: Département de Chirurgie, Hôpital Intercantonale de la Broye, Avenue de la Colline 3, 1530, Payerne, Switzerland. garofalofabio@inwind.it.|Département de Chirurgie, Division de Chirurgie Bariatrique, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, 5400 boul. Gouin ouest, Montréal, QC, H4J 1C5, Canada. garofalofabio@inwind.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Garofalo
authors.affiliation: Département de Chirurgie, Hôpital Intercantonale de la Broye, Avenue de la Colline 3, 1530, Payerne, Switzerland.
authors.forename: Pau
authors.initials: P
authors.lastname: Mota-Moya
authors.affiliation: Département de Chirurgie, Hôpital Intercantonale de la Broye, Avenue de la Colline 3, 1530, Payerne, Switzerland.
authors.forename: Andrew
authors.initials: A
authors.lastname: Munday
authors.affiliation: Département de Chirurgie, Hôpital Intercantonale de la Broye, Avenue de la Colline 3, 1530, Payerne, Switzerland.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Romy
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D013502:General Surgery / Q000193:education*; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000193:education* / Q000379:methods; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education* / Q000379:methods; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010537:Peritoneum / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D013557:Switzerland; D016896:Treatment Outcome