Ignite Creation Date:
2024-05-06 @ 8:15 PM
Last Modification Date:
2024-10-26 @ 3:24 PM
Study NCT ID:
NCT06314802
Status:
RECRUITING
Last Update Posted:
2024-03-18
First Post:
2024-03-11
Brief Title:
Learning Curve of the Shouldice Procedure
Sponsor:
Shouldice Hospital
Organization:
Shouldice Hospital
Study Overview
Official Title:
Evaluation of the Learning Curve of the Shouldice Procedure
Status:
RECRUITING
Status Verified Date:
2024-03
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
LCSR
Brief Summary:
Hernia repair surgery is common especially the Shouldice repair for primary inguinal hernias which is considered a top-notch nonmesh technique However outcomes can vary possibly due to differences in surgical skill and experience Many surgeons are trained more in mesh repairs like the Lichtenstein technique rather than nonmesh repairs like Shouldice
Understanding a surgeons learning curve-how many surgeries they need to do to become proficient-is crucial Yet theres not much research on this for the Shouldice repair This project aims to fill that gap and improve surgeon education
The studys goal is to find out how the learning curve affects Shouldice repair for primary inguinal hernias Theyll look at how operative time changes over a surgeons first 300 repairs compared to their 900-1000th Theyll also check for complications and recurrence rates
The study objectives are
1 Explore the learning curve and factors affecting Shouldice repair
2 Compare operative times between a surgeons early and later surgeries
3 Look at complications during the learning curve
4 Determine how long training takes at Shouldice Hospital and the surgeons previous experience
5 Review recurrence rates between the first 300 and 900-1000 surgeries
This research aims to give surgeons and the hernia community valuable insights into improving surgical techniques and patient outcomes
Understanding a surgeons learning curve-how many surgeries they need to do to become proficient-is crucial Yet theres not much research on this for the Shouldice repair This project aims to fill that gap and improve surgeon education
The studys goal is to find out how the learning curve affects Shouldice repair for primary inguinal hernias Theyll look at how operative time changes over a surgeons first 300 repairs compared to their 900-1000th Theyll also check for complications and recurrence rates
The study objectives are
1 Explore the learning curve and factors affecting Shouldice repair
2 Compare operative times between a surgeons early and later surgeries
3 Look at complications during the learning curve
4 Determine how long training takes at Shouldice Hospital and the surgeons previous experience
5 Review recurrence rates between the first 300 and 900-1000 surgeries
This research aims to give surgeons and the hernia community valuable insights into improving surgical techniques and patient outcomes
Detailed Description:
Hernia repair is one of the most commonly performed general surgeries 1 Shouldice repair for primary inguinal hernias is a well-known and documented surgical technique 23 and considered to be the gold standard nonmesh hernia repair 1 The results in the literature for a Shouldice primary inguinal hernia repair vary greatly 245 and may be due to a lack of accuracy in performing the repair 56 andor lack of surgical volume and experience 7-9 An added contributing factor could be that nonmesh repairs are not principally taught to many residents instead the primary method taught is the Lichtenstein repair 10 which leaves out early training of nonmesh repairs like the Shouldice Repair
Learning curve can evaluate surgeons performance and status trainee or expert which is done by determining the minimum number of procedures it takes to reach similar outcomes as known expert surgeons 10 However there is limited research that describes learning curve and the minimum number of hernia techniques to perform before being considered proficient 111 Some research has performed analysis which focused on operating times to determine the learning curve for the Lichtenstein 10 and similar learning and proficiency research on TAPP 12 hernia repair procedures
The rationale for this project is to supply valuable information to general surgeon trainees and experts as well as the broader hernia community There is little to no research done on the learning curve of the Shouldice repair for primary inguinal hernias and the importance of offering and learning nonmesh hernia repairs are associated with the risk of complications after mesh use as well as treating patients who would prefer a nonmesh repairs 1 Therefore the significance of this project is to improve the understanding and knowledge regarding Shouldice Repair and increase surgeon education
The purpose of this study is to determine the learning curve of a Shouldice repair for primary inguinal hernias The primary endpoint is differences in operative length while secondarily evaluating recurrence rate and other complications
Study Objectives
1 To examine the learning curve and contributing variables of a Shouldice primary inguinal hernia repair
2 To compare operative time between a surgeons first 300 Shouldice primary inguinal hernia repairs and their 900-1000
3 To review learning curve and postoperative complications
4 To determine the training period at Shouldice Hospital and examine prior experience of surgeons
5 To review mean time to recurrence during a surgeons first 300 Shouldice primary inguinal hernia repairs and their 900-1000
The proposed project is a pilot study consisting of a retrospective review to collect information on the learning curve of a Shouldice primary inguinal hernia repair done at Shouldice Hospital The study will consist of surgeons who worked at Shouldice Hospital in 2023 were hired within the past 10 years and performed a minimum of 1000 primary inguinal hernia repairs We estimate 4 surgeons to be included The study will compare surgeons first 300 Shouldice primary inguinal hernia repairs to their 900-1000 The parameters of 300 and 1000 hernia repairs were chosen based on previous publications 13 which used those benchmarks to indicate proficiency and expertise of the repair We will analyze the learning curve by using operating time which has also been done for Lichtenstein 10 and similar research in TAPP 12 hernia repairs
1 The HerniaSurge Group 2018 International guidelines for groin hernia management Hernia 221-165 https doi org 10 1007s10029- 017- 1668-x
2 Shouldice EB 2003 The Shouldice repair for groin hernias Surg Clin N Am 831163-1187
3 Mainprize M Spencer Netto FAC Degani C et al The Shouldice Method an experts consensus Hernia 27 147-156 2023 httpsdoiorg101007s10029-022-02658-y
4 Shouldice EB 2010 Surgery illustrated-surgical atlas the Shouldice natural tissue repair for inguinal hernia BJUI 105428-439
5 Lorenz R Arlt G Fortelny R Gorjanc J Koch A Morrison JOprea V Campanelli G 2020 Shouldice standard 2020 review of the current literature an results of an international consensus meeting Hernia 2551199-1207
6 Malik A Bell CM Stukel TA Urbach DR 2016 Recurrence of inguinal hernias repaired in a large hernia surgical speciality hospital and general hospitals in Ontario Can J Surg 59119-25
7 Andresen K Friis-Andersen H Rosenberg J 2016 Laparoscopic repair of primary inguinal hernia performed in public hospitals or low-volume centers have increased risk of reoperation for recurrence Surg Innov 23142-147
8 Kockerling F Bitter R Kraft B Hukauf M Kuthe A Schug-Pass C 2017 Does surgeons volume matter in the outcome of endoscopic inguinal hernia repair Surg Endosc 31573-585
9 Nordin P van der Linden W 2008 Volume of procedures and risk of recurrence after repair of gorin hernias national register study Br Med J 336934-937
10 Merola G Cavallaro G Iorio O Frascio M Pontecorvi E Corcione F Andreuccetti J Pignata G Stabilini C and Bracale U Learning curve in open inguinal hernia repair a quality improvement multicentre study about Lichtenstein technique Hernia 2020 24651-659 httpsdoiorg101007s10029-019-02064-x
11 Simons MP Aufenacker T Bay-Nielsen M Bouillot JL Campanelli G Conze J de Lange D Fortelny R Heikkinen T Kingsnorth A Kukleta J Morales-Conde S Nordin P Schumpelick V Smedberg S Smietanski M Weber G Miserez M European Hernia Society guidelines on the treatment of inguinal hernia in adult patients Hernia 2009 13343-403
12 Brucchi F Ferraina F Masci E Ferrara D Bottero L and Faillace GG Standardization and learning curve in laparoscopic hernia repair experience of a high-volume center BMC Surgery 2023 23212 httpsdoiorg101186s12893-023-02119-y
Supplemental Material
Learning curve can evaluate surgeons performance and status trainee or expert which is done by determining the minimum number of procedures it takes to reach similar outcomes as known expert surgeons 10 However there is limited research that describes learning curve and the minimum number of hernia techniques to perform before being considered proficient 111 Some research has performed analysis which focused on operating times to determine the learning curve for the Lichtenstein 10 and similar learning and proficiency research on TAPP 12 hernia repair procedures
The rationale for this project is to supply valuable information to general surgeon trainees and experts as well as the broader hernia community There is little to no research done on the learning curve of the Shouldice repair for primary inguinal hernias and the importance of offering and learning nonmesh hernia repairs are associated with the risk of complications after mesh use as well as treating patients who would prefer a nonmesh repairs 1 Therefore the significance of this project is to improve the understanding and knowledge regarding Shouldice Repair and increase surgeon education
The purpose of this study is to determine the learning curve of a Shouldice repair for primary inguinal hernias The primary endpoint is differences in operative length while secondarily evaluating recurrence rate and other complications
Study Objectives
1 To examine the learning curve and contributing variables of a Shouldice primary inguinal hernia repair
2 To compare operative time between a surgeons first 300 Shouldice primary inguinal hernia repairs and their 900-1000
3 To review learning curve and postoperative complications
4 To determine the training period at Shouldice Hospital and examine prior experience of surgeons
5 To review mean time to recurrence during a surgeons first 300 Shouldice primary inguinal hernia repairs and their 900-1000
The proposed project is a pilot study consisting of a retrospective review to collect information on the learning curve of a Shouldice primary inguinal hernia repair done at Shouldice Hospital The study will consist of surgeons who worked at Shouldice Hospital in 2023 were hired within the past 10 years and performed a minimum of 1000 primary inguinal hernia repairs We estimate 4 surgeons to be included The study will compare surgeons first 300 Shouldice primary inguinal hernia repairs to their 900-1000 The parameters of 300 and 1000 hernia repairs were chosen based on previous publications 13 which used those benchmarks to indicate proficiency and expertise of the repair We will analyze the learning curve by using operating time which has also been done for Lichtenstein 10 and similar research in TAPP 12 hernia repairs
1 The HerniaSurge Group 2018 International guidelines for groin hernia management Hernia 221-165 https doi org 10 1007s10029- 017- 1668-x
2 Shouldice EB 2003 The Shouldice repair for groin hernias Surg Clin N Am 831163-1187
3 Mainprize M Spencer Netto FAC Degani C et al The Shouldice Method an experts consensus Hernia 27 147-156 2023 httpsdoiorg101007s10029-022-02658-y
4 Shouldice EB 2010 Surgery illustrated-surgical atlas the Shouldice natural tissue repair for inguinal hernia BJUI 105428-439
5 Lorenz R Arlt G Fortelny R Gorjanc J Koch A Morrison JOprea V Campanelli G 2020 Shouldice standard 2020 review of the current literature an results of an international consensus meeting Hernia 2551199-1207
6 Malik A Bell CM Stukel TA Urbach DR 2016 Recurrence of inguinal hernias repaired in a large hernia surgical speciality hospital and general hospitals in Ontario Can J Surg 59119-25
7 Andresen K Friis-Andersen H Rosenberg J 2016 Laparoscopic repair of primary inguinal hernia performed in public hospitals or low-volume centers have increased risk of reoperation for recurrence Surg Innov 23142-147
8 Kockerling F Bitter R Kraft B Hukauf M Kuthe A Schug-Pass C 2017 Does surgeons volume matter in the outcome of endoscopic inguinal hernia repair Surg Endosc 31573-585
9 Nordin P van der Linden W 2008 Volume of procedures and risk of recurrence after repair of gorin hernias national register study Br Med J 336934-937
10 Merola G Cavallaro G Iorio O Frascio M Pontecorvi E Corcione F Andreuccetti J Pignata G Stabilini C and Bracale U Learning curve in open inguinal hernia repair a quality improvement multicentre study about Lichtenstein technique Hernia 2020 24651-659 httpsdoiorg101007s10029-019-02064-x
11 Simons MP Aufenacker T Bay-Nielsen M Bouillot JL Campanelli G Conze J de Lange D Fortelny R Heikkinen T Kingsnorth A Kukleta J Morales-Conde S Nordin P Schumpelick V Smedberg S Smietanski M Weber G Miserez M European Hernia Society guidelines on the treatment of inguinal hernia in adult patients Hernia 2009 13343-403
12 Brucchi F Ferraina F Masci E Ferrara D Bottero L and Faillace GG Standardization and learning curve in laparoscopic hernia repair experience of a high-volume center BMC Surgery 2023 23212 httpsdoiorg101186s12893-023-02119-y
Supplemental Material
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None