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ID: 227 (Conflict of Interest: K)

Leistenhernienreparation beim männlichen Säugling – als Ausbildungsoperation geeignet?

L.Yilmaz1, R.-B.Tröbs2
1Universitätsklinik Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Herne
2Stiftung Katholisches Krankenhaus Marienhospital Herne, Herne

Einleitung

Inguinal hernia repair (IHR) is the most common abdominal surgical procedure in neonates and infants. Under the pressure of time economy in the OR hernia repair has to be performed quickly and complications rates should be very low. The aim of the presented study was to compare the operation times and the postoperative complication rate of IHR either performed by a board certified surgeon (BCS) or performed by an pediatric assistant surgeon in medical specialist training.

Material und Methoden

We present a retrospective, non-randomized monocenter study over 30 months (2012 to 2014).  183 male infants with a postnatal age below 365 days with uni- (n=148) or bilateral (n=35) open IHR were included.  We compared operation times regarding the board certification of the first operator (assistant surgeon vs. BCS). Exclusion criteria were female sex, age over 365 days, and additional operations performed together with IHR. Operations performed by surgeons doing less than 10 IHR’s during the observation period were also excluded. Operation times were estimated according to the operation records. Complications were identified with help of the ICD-10 coding (category T). For statistics we mainly applied the Mann & Whitney U-test.

Ergebnisse

Mean median postnatal age of infants was 82 days and did not differ between both groups.

A total of 67 IHR was performed by assistant surgeons, and 116 were done by BCS. Generally, the number of patients operated on by trainees was significant lower (p= 0.000; exact binominal test) than BCS procedures. For unilateral hernia repair operation times remained 32±14 min (Trainees) vs. 36±23 min (BCS); p=0.75.  For bilateral hernia repair operation times were 49±17 min. vs. 58±27 min; p=0.81.  We observed a learning curve for trainees with increasing experiences.

We registered 7 complications: bleeding (signif. hematoma (n=3), wound  infection (n=3),  and laceration of the omentum (n=1).

 

Schlussfolgerung

Inguinal hernia repair in infants is an index operation for the training in pediatric surgery. We have shown that IHR can be performed quick and safe by doctors in training program for pediatric surgery. In the majority of cases IHR can be planned as teaching operation.