Acta Biomedica Scientia

TRAINING CHALLENGES AND THE COMPLEXITY OF ABDOMINAL WALL SURGERY: INSIGHTS FROM LITERATURE AND THE HERNIAMED REGISTRY

Dr. Gupta M.V.S.N

-Surgical training, Learning curve, Complex hernias, Tailored approach, Inguinal hernia, Incisional hernia.

ACCESS, a program organized by the European Hernia Society (EHS), also acknowledges the emerging requirement of developing specialists in the area of abdominal wall. The rationale for this proposal is the fact that more recent methods of abdominal wall surgery are not as easily controlled as before, more so because the effectiveness varies among patients, hence the need to base the treatment on the type of patient in question. The other one revolves around the use of the internet where patients themselves present the best results of a surgery. But there is scant information and literature regarding the specialization related to abdominal wall surgery or what it involves. A search of the papers was done in May 2019 from Medline, PubMed, Scopus, Embase, Springer Link, and Cochrane library, out of which the authors were able to find 75 papers. Various results obtained from the Herniamed Hernia Registry were compared and percentage of the cases that had an unfavorable influence on ARM like hernia or patient related factors in regard to the inguinal or incisional hernia repair was done. The recent guideline regarding the abdominal wall surgery state that they should be made individualized. This approach takes for granted that the surgeon operating on the patient has the best of the techniques and knowledge and that each of the approaches in inguinal hernia repair (Lichtenstein, TEP, TAPP Shouldice) and the incisional hernia repair (laparoscopic IPOM, open sublay, open IPOM, open onlay, open/endoscopic component separation) have their own learning curve. Other factors that makes an operation complex are emergency operations, obesity, recurrences, bilateral inguinal hernias, hernias in women, scrotal hernias, big hole, high ASA scores, operation age 80 years and above, higher medical risk, and past lower abdominal operations. According to the data of the Herniamed Hernia Registry, 69.7% of the patients had at least one of the above-mentioned characteristics. Training of the general surgeon involves performing between 50- 100 hernia operations, of which 25 are laparo-endoscopic. The individualization of care has gradually applied and is more often discussed in hernia surgery and in the current hernia guidelines. Moreover, because it has become more complex to perform an abdominal wall surgery, there are still not many cases that can be handled by the trainees to solve the learning curve that was noted. Consequently, young surgeons should embark on their clinical fellowships for the purpose of obtaining qualifications in abdominal wall surgery as well as improve on their clinical and operative skills while under supervision. Therefore, to upgrade the knowledge of the practicing general surgeons regarding hernia surgery, they should pursue a more comprehensive surgical technique through clinical observation, purposeful clinical workshops, and forums