Who will repair the next open inguinal hernia? Educational consequences of declining open surgery volumes.

Open inguinal hernia repair is now a low-volume operation, with declines in long-term outcomes. Maintaining broad competence in open repair through traditional surgical training pathways no longer seems realistic.

Centralizing open hernia surgery at dedicated centers or with specialized surgeons, along with a stronger emphasis on laparoscopic training, may be necessary to preserve quality, safety, and training opportunities.