Surgeon Annual Volume Impacts Recurrence Rates of Pediatric Inguinal Hernia Repairs | Multi-institution Retrospective Cohort | 2017-2019 | 207 surgeons | Annual case volume | 21 children's hospitals | 8,519 total hernia repairs | Higher Volume: > 22 operations/year | Factors associated with higher recurrence risk in ALL repairs: | ventriculoperitoneal shunt | laparoscopic technique | lower surgeon annual volume | peritoneal dialysis | Surgeon volume was NOT associated with recurrence for open repairs | Surgeon volume was associated with recurrence for laparoscopic repairs | Conclusion: Surgeon annual volume is a key determinant of recurrence, primarily in laparoscopic hernia repairs. Surgeons performing both techniques should maintain adequate annual volume. | https://pubmed.ncbi.nlm.nih.gov/41475507/ | Heller K et al. | Division of Pediatric Surgery, Phoenix Children's, Phoenix, AZ, USA | Journal of Pediatric Surgery | @LizzyPAC8 | @globalcastmd | @StayCurrentMD | Cincinnati Children's
Surgeon Annual Volume Impacts Recurrence Rates of Pediatric Inguinal Hernia Repairs: A Multi-Institutional Study
Infographic · Jan 2026 · 2 min read
In brief
In brief
Multi-institutional study of 8,519 pediatric inguinal hernia repairs found surgeon annual volume significantly impacts recurrence rates for laparoscopic repairs (>14 cases/year threshold) but not open repairs. Findings suggest surgeons should maintain adequate volume in each technique to ensure proficiency and optimal outcomes.
- Surgeon annual volume significantly impacts recurrence rates for laparoscopic pediatric inguinal hernia repair but not open repair.
- Higher volume defined as >14 laparoscopic cases/year; surgeons below this threshold have increased recurrence risk.
- VP shunt presence and laparoscopic technique are independent risk factors for hernia recurrence across all repair types.
- Surgeons using both open and laparoscopic approaches must maintain adequate volume in each technique to preserve proficiency.
- Patient factors (connective tissue disorder, omphalocele, tracheostomy) increase recurrence risk in open repairs regardless of volume.
Written by the GCMD Library team from the infographic.
The infographic uses a teal, gray, and yellow color scheme with cartoon illustrations of surgeons and patients. The layout is divided into sections with the top portion highlighting study details and surgeon numbers, the middle section showing risk factors in colored text, and the bottom containing the conclusion in a yellow banner. Medical illustrations include a surgeon at a computer workstation and a surgical team operating.
Kathleen Heller, Brielle V Ochoa, Stephanie Brierley, Benjamin E Padilla; Pediatric Inguinal Hernia Collaborative Group; Amir Alhajjat, Emily Byrd, Stephanie D Chao, Christopher Clinker, Jose Diaz-Miron, Goeto Dantes, R Scott Eldredge, Elizabeth A Fialkowski, Yigit Guner, Juan P Gurria, Zaid Haddadin, Alexandra Highet, Carlos T Huerta, Olivia A Keane, Lorraine I Kelley-Quon, Pablo Laje, Hau Le, Justin Lee, Aaron Lesher, Saunders Lin, Lauren Lym, Samir R Pandya, Steven Papastefan, Raphael H Parrado, Eduardo A Perez, Cynthia Ramazani, Warren Rehrer, Katie W Russell, Leigh Selesner, Blynn L Shideler, Bethany J Slater, Michael A Stellon, Caroline Stephens, Krysta M Sutyak, KuoJen Tsao, Cristine S Velazco, Nell Weber, Nathaniel Westbrook, Minna M Wieck, Peter Yu
Purpose: This study aimed to investigate effect of surgeon annual case volume on pediatric inguinal hernia recurrence rates.
Methods: Surgeons' individual annual case volumes were calculated from a retrospectively collected data set of pediatric inguinal hernia repairs including 21 hospitals from 2017-2019. Quartiles were defined based on surgeons' annual case volumes for each year: Lower Volume=Q1-3 and Higher Volume=Q4. Descriptive statistics and bivariate regression were utilized for analysis.
Results: For all repair techniques, there were 207 surgeons accounting for 548 surgeon-years with 8,519 operations. For all repairs, Higher Volume was defined as > 22 operations per year. On regression analysis, presence of a ventriculoperitoneal shunt, peritoneal dialysis, laparoscopic technique, and surgery performed by a lower volume surgeon were associated with recurrence risk. For open repairs, there were 193 surgeons, 465 surgeon-years, and 5,726 operations. Higher Volume was defined as >18 operations per year. On regression analysis, history of an omphalocele, a connective tissue disorder, and tracheostomy dependence contributed to recurrence risk, while surgeon volume did not. For laparoscopic repairs, there were 136 surgeons, 306 surgeon-years, and 2793 operations. High Volume was defined as >14 operations per year. On regression analysis, presence of a ventriculoperitoneal shunt and surgeon laparoscopic volume was associated with recurrence risk.
Conclusions: Annual surgical volume is an important determinant of recurrence following laparoscopic inguinal hernia repair. As surgeons integrate both laparoscopic and open techniques in their practice, caution should be taken to maintain adequate volume and proficiency in each technique.
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.