Surgeon annual volume impacts recurrence rates of pediatric inguinal hernia repairs: A multi-institutional study

What the Study Found

A multi-institutional study by Heller et al. examined how surgeon annual volume affects recurrence rates in pediatric inguinal hernia repair 0:10. Overall, lower-volume surgeons had a 1.5-fold increase in the odds of recurrence compared to higher-volume surgeons 0:22.

The critical finding emerged when the authors separated outcomes by surgical approach 0:10. For open repairs, surgeon volume made no difference in recurrence rates 0:30. For laparoscopic repairs, however, lower-volume surgeons had a 3.3-fold increase in the odds of recurrence 0:35.

What This Means for Training and Practice

The technique-specific volume effect suggests that laparoscopic inguinal hernia repair has either a steeper learning curve or requires more frequent repetition to maintain proficiency than open repair 0:35. A surgeon who performs adequate total hernia volume but splits that volume between open and laparoscopic approaches may not maintain sufficient laparoscopic volume to achieve optimal outcomes 0:35.

The authors recommend that surgeons either maintain a high volume of laparoscopic repairs specifically, or consult a higher-volume colleague when laparoscopic repair is planned 0:44. This is not a blanket recommendation against laparoscopic repair—it is a recommendation about who should perform it and under what circumstances 0:44.

Implications for Your Practice

If you are training in pediatric surgery, track your volume in each technique separately 0:35. The total number of inguinal hernias you repair matters less than how many you perform using each specific approach 0:35. If your institution's case mix limits your laparoscopic volume, seek additional experience or consider defaulting to open repair until your laparoscopic volume increases 0:44.

If you are already in practice with lower laparoscopic volume, the data support either concentrating your cases to build volume, referring laparoscopic cases to a higher-volume colleague, or performing open repairs when both approaches are reasonable 0:44. The study does not define the volume threshold that separates higher- from lower-volume surgeons, so the specific number remains unclear 0:10.

Volume-Outcome Relationship

A 2025 multi-institutional study by Heller et al. in the Journal of Pediatric Surgery examined how surgeon case volume affects recurrence rates in pediatric inguinal hernia repair 0:10. Overall, lower-volume surgeons had a 1.5-fold increase in recurrence odds 0:22. The effect, however, was technique-specific 0:30 0:35.

Open Versus Laparoscopic Outcomes

For open repairs, surgeon volume made no difference in recurrence rates 0:30. For laparoscopic repairs, the gap widened substantially: lower-volume surgeons had a 3.3-fold increase in recurrence odds 0:35. This suggests that laparoscopic technique either has a steeper learning curve or requires more frequent repetition to maintain proficiency 0:35.

Implications for Practice

The authors recommend that surgeons maintain high laparoscopic repair volume, and when that is not feasible, consult or refer to higher-volume colleagues 0:44. This is not about credentialing thresholds—it is about recognizing that technical outcomes in minimally invasive pediatric surgery depend on sustained practice 0:35 0:44. A surgeon who performs predominantly open repairs cannot assume equivalent skill transfer when occasionally performing laparoscopic cases 0:30 0:35.

For non-surgeons managing these patients, this study clarifies one contributor to recurrence risk 0:10 0:22. When a child presents with recurrent inguinal hernia after laparoscopic repair, low surgeon volume is a plausible factor 0:35. It does not explain every recurrence, but it is now a documented variable 0:10 0:22. If you are referring a pediatric patient for inguinal hernia repair and laparoscopic approach is planned, it is reasonable to ask about the surgeon's annual case volume in that specific technique 0:35 0:44.