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The case for a new post-graduate hernia designation: a review of fellowship council case logs from the past twelve-years

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Abstract

Background

The Fellowship Council (FC) is a robust accreditation body with numerous fellowships; however, no specific criteria exist for hernia fellowships. This study analyzed the case log database to evaluate trends in fellowship exposure to hernia repairs.

Methods

FC hernia case log records (2007–2019) were coded as inguinal or ventral hernias and with or without mesh repair. Retrospective analysis examined total hernia repairs logged, type of repair, program designation, and robotic adoption. Robotic adoption was categorized by quartiles of program performance according to the final year of analysis (2018–2019); yearly performance was then graphed by quartiles.

Results

Over this twelve-year period, 93,334 hernia repairs, 5 program designations, 152 unique programs and 1,558 unique fellows were analyzed. The number of fellows grew from 106 (2007–2008) to > 130 (2018–2019). Total hernias repairs per fellow increased from an average of 41.2 in 2007–2008 to 75.7 in 2018–2019 (183.7%). Open and robotic hernia repairs increased by 241.9% and 266.3%, respectively; laparoscopic hernia repairs decreased by 14.8%. Inguinal and ventral hernia repairs comprised 48.1% and 51.9% of total cases, respectively.

Advanced GI/MIS and Advanced GI/MIS/Bariatrics programs logged the majority of hernia repairs (86.0–90.2%). 2014 began an exponential rise in robotic adoption, with fellows averaging < 1 robotic repairs before and > 25 repairs in 2019. A significant difference was found between all groups when comparing quartiles of robotic adopters (median robotic repairs per fellow; IQR): first quartile (72.0; 47.9–108.8), second quartile (25.5; 21.0–30.6), third quartile (13.0; 12.0–14.3) and fourth quartile (3.5; 0.5–5.0) (p-value < 0.05).

Conclusions

This twelve-year analysis shows a near doubling in the growth of total hernia repairs, with a decrease in laparoscopic repairs as robotic repairs increased. These data show the importance of hernia repairs in FC fellows’ training and warrant further granular analysis to determine specific accreditation criteria for hernia fellowship designations.

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Acknowledgements

The authors would like to thank the Fellowship Council and supporting institutions for their support and collaboration. Additionally, the authors would like to thank the fellows and programs whose hernia experiences contributed to this work. This manuscript has been reviewed and approved by the FC well as the AHS and SAGES (including the SAGES Community Practice Committee).

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There was no funding.

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Authors and Affiliations

  1. Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA

    Madhuri B. Nagaraj & Daniel J. Scott

  2. Department of Surgery, University of California at San Francisco, 513 Parnassus Ave, S320, San Francisco, CA, 94143, USA

    Adnan Alseidi

  3. Department of Surgery, The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44113, USA

    Ajita S. Prabhu

  4. Department of Surgery, Duke University, 2310 Erwin Road, Durham, NC, 27710, USA

    Jacob A. Greenberg

  5. Department of Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA

    Michael M. Awad

  6. Department of Surgery, University of Texas Houston Health Science Center, 6431 Fannin St, Houston, TX, 77030, USA

    Joshua J. Weis

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  1. Madhuri B. Nagaraj
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Correspondence to Madhuri B. Nagaraj.

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Disclosures

Dr. Ajita S. Prabhu is a consultant for Verb Surgical and CMR Surgical, as well as a speaker and research support for Intuitive Surgical. Drs. Madhuri B. Nagaraj, Adnan Alseidi, Jacob A. Greenberg, Michael M. Awad, Joshua J. Weis, and Daniel J. Scott have have no conflicts of interest or financial ties to disclose.

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Nagaraj, M.B., Alseidi, A., Prabhu, A.S. et al. The case for a new post-graduate hernia designation: a review of fellowship council case logs from the past twelve-years. Surg Endosc 37, 3430–3438 (2023). https://doi.org/10.1007/s00464-022-09800-y

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