Low Uptake of Laparoscopic Inguinal Hernia Repair: What Are the Barriers for Surgeons in Practice?

Michael Trevisonno, Pepa Kaneva, Ekaterina Lebedeva, Liane S. Feldman, Gerald M. Fried, Melina C. Vassiliou

Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre

Introduction:
Laparoscopic inguinal hernia repair (LIHR) has not gained widespread acceptance, and is not as commonly practiced compared to many other laparoscopic procedures. This may be related to the steep learning curve, during which complications and recurrence rates are increased. The purpose of this study was to identify the barriers and educational needs of practicing surgeons with regards to LIHR.

Methods:
A web-based survey was sent via email to general surgery members of the following North American surgical societies: The American College of Surgeons, the Canadian Association of General Surgeons, the Society of American Gastrointestinal and Endoscopic Surgeons, the American Hernia Society, and the Quebec and Ontario Associations of General Surgeons. The 33-item survey was divided in 4 sections: demographics, utilization, management based on clinical scenarios, and educational needs and barriers to laparoscopic repair, which is the focus of this study.

Results:
697 practicing general surgeons who treat patients with inguinal hernias responded to the survey of whom 327 (48%) never perform laparoscopic repair. Of the surgeons that never perform LIHR, 200 (61%) consider the benefits of laparoscopy to be minimal, 167 (51%) say they lack the requisite training and experience, and only 79 (24%) want to learn. For the surgeons who want to learn, barriers included lack of time (56%) and safety concerns during the learning curve (35%). These surgeons responded that their preferred educational methods would be: A course followed by expert proctoring (72%), observation of experts in the OR (57%), weekend courses with cadavers (35%), a mini-fellowship (33%), and simulation (32%). The majority (51%) said that the most feasible method in their practice would be a course followed by expert proctoring.

Conclusion:
Almost half of the surgeons surveyed never perform laparoscopic inguinal hernia repair. The main barrier for its adoption is a lack of training and experience. One quarter of practicing surgeons who do not use LIHR would be interested in learning this procedure. This reveals a knowledge gap that could be addressed with educational programs. The most desirable method seems to be a course followed by expert proctoring.

Session: Poster Presentation

Program Number: P290