The case for a new post-graduate hernia designation: a review of fellowship council case logs from the past twelve-years

Background: The Fellowship Council (FC) is a robust accreditation body with numerous fellowships; however, no specific criteria exist for hernia fellowships. This study analyzed the case log database to evaluate trends in fellowship exposure to hernia repairs. Methods: FC hernia case log records (2007–2019) were coded as inguinal or ventral hernias and with or without mesh repair. Retrospective analysis examined total hernia repairs logged, type of repair, program designation, and robotic adoption. Robotic adoption was categorized by quartiles of program performance according to the final year of analysis (2018–2019); yearly performance was then graphed by quartiles. Results: Over this twelve-year period, 93,334 hernia repairs, 5 program designations, 152 unique programs and 1,558 unique fellows were analyzed. The number of fellows grew from 106 (2007–2008) to > 130 (2018–2019). Total hernias repairs per fellow increased from an average of 41.2 in 2007–2008 to 75.7 in 2018–2019 (183.7%). Open and robotic hernia repairs increased by 241.9% and 266.3%, respectively; laparoscopic hernia repairs decreased by 14.8%. Inguinal and ventral hernia repairs comprised 48.1% and 51.9% of total cases, respectively. Advanced GI/MIS and Advanced GI/MIS/Bariatrics programs logged the majority of hernia repairs (86.0–90.2%). 2014 began an exponential rise in robotic adoption, with fellows averaging < 1 robotic repairs before and > 25 repairs in 2019. A significant difference was found between all groups when comparing quartiles of robotic adopters (median robotic repairs per fellow; IQR): first quartile (72.0; 47.9–108.8), second quartile (25.5; 21.0–30.6), third quartile (13.0; 12.0–14.3) and fourth quartile (3.5; 0.5–5.0) (p-value < 0.05). Conclusions: This twelve-year analysis shows a near doubling in the growth of total hernia repairs, with a decrease in laparoscopic repairs as robotic repairs increased. These data show the importance of hernia repairs in FC fellows’ training and warrant further granular analysis to determine specific accreditation criteria for hernia fellowship designations.