Long-Term Outcomes Following Laparoscopic Repair of Large Hiatus Hernias Performed by Trainees Versus Consultant Surgeons

Background: The laparoscopic approach is the preferred method for repair of large hiatus hernias but can be technically challenging. Training surgeons need experience as the primary operator to gain competency in this operation. However, learning the procedure should not compromise the functional long-term outcome for patients. The aim of this study was to determine whether any difference in long-term outcomes exists for patients having a laparoscopic large hiatus hernia repair performed by a trainee versus a consultant surgeon. Methods: A total of 648 suitable patients who had undergone laparoscopic repair of a large hiatus hernia were identified from a prospective database. Cases were divided into two groups based on whether the primary operator was a trainee or a consultant surgeon. Demographics, perioperative data, revisions and patient-reported clinical outcomes via standardised questionnaires were compared. Results: There were no statistically significant differences in the clinical outcomes for patients undergoing laparoscopic repair of a large hiatus hernia performed by a trainee versus a consultant surgeon, with comparable patient-reported outcomes for heartburn, dysphagia, and overall satisfaction with the outcome following surgery. Median operative time was approximately 20 min longer for trainees (p = <0.0001). Revisional surgery rates were similar for the two groups. Conclusions: Patients operated on by trainees have equivalent long-term clinical outcomes to patients operated on by consultant surgeons. For these patients, surgery can be safely performed by supervised trainees.