pp 1–9 | Cite as

Learning curve in open inguinal hernia repair: a quality improvement multicentre study about Lichtenstein technique

  • G. Merola
  • G. Cavallaro
  • O. Iorio
  • M. Frascio
  • E. Pontecorvi
  • F. Corcione
  • J. Andreuccetti
  • G. Pignata
  • C. Stabilini
  • U. BracaleEmail author
Original Article
Part of the following topical collections:
  1. Education, Accreditation, Hernia Center



Inguinal hernia repair is one of the most performed procedure all over the world with more than 20 million procedures performed each year. Due to the lack of data in literature about the learning curve of the Lichtenstein procedure, we decided to reproduce a research on learning curves with the same methodology proposed in our previous study about laparoscopic hernia repair. The aim of this multicentre study was to analyse how many cases are required to achieve the learning curve for a Lichtenstein procedure.


We performed a retrospective analysis of the first 100 Lichtenstein procedures performed by 4 trainees from three different institutions and compared them with the same number of procedures performed by 3 senior surgeons from the same institutions. The data about the achieving of learning curve were evaluated with CUSUM and KPSS test.


No differences about biometrical features were found between the seven groups of patients. CUSUM analysis showed that the trainees achieve the learning curve after 37–42 procedures, reaching an operative time similar to that one of the senior surgeons.


In conclusion, we have shown that the number of procedures required to reach the learning curve from the beginning of surgical residency is around 40 hernia repairs. This number, produced in a controlled environment under strict supervision, could be the minimum requirement to start the procedure of accreditation and specialization in hernia surgery and is higher and steeper than previously reported.


Learning curve Training Inguinal hernia repair Teaching in surgery Lichtenstein 


Compliance with ethical standards

Conflict of interest

All the authors declare that they have no conflict of interest.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institute and regional research committee and with the 1694 Helsinki declaration and its later amendments or comparable ethical standards. Moreover, ethical approval was sought but not deemed necessary by the hospital research committee, due to retrospective nature of the paper.

Human and animal rights

There are no human and animal rights issue to declare.

Informed consent

Due to the retrospective nature of the study a formal consent is not required.

Supplementary material

10029_2019_2064_MOESM1_ESM.docx (16 kb)
Supplementary file1 (DOCX 15 kb)


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Gastroenterology, Endocrinology and Surgical Endoscopy, School of MedicineUniversity Hospital Federico II of NaplesNaplesItaly
  2. 2.Department of Surgery “P. Valdoni”, School of MedicineUniversity Hospital “La Sapienza” of RomeRomeItaly
  3. 3.Department of Surgical Sciences, School of MedicineUniversity of GenoaGenoaItaly
  4. 4.Department of General and Mininvasive Surgery“San Camillo” Hospital of TrentoTrentoItaly
  5. 5.Department of General Surgery IICivil Hospital of BresciaBresciaItaly

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