Inguinal hernia surgery in the Netherlands: are patients treated according to the guidelines?

Purpose In 2003, a dedicated Dutch committee developed vidence-based guidelines for the treatment of nguinal hernia (IH) in children and adults. The aim of this tudy was to describe trends in hernia care before and after he publication of the guidelines on IH surgery in the etherlands. ethods Originally, a retrospective baseline analysis of H surgery in 90 Dutch hospitals was performed among atients treated for IH in 2001. The results of this baseline nalysis were compared with a recently performed second nalysis of patients treated for IH in 2005. esults In children\\4 years of age, the study showed a ignificant decrease of contralateral explorations. In adults, he study showed that significantly more patients were reated with a mesh-based repair in 2005 (95.9 vs. 78.8%, <0.01eover, there was an increase of patients ith bilateral hernia treated with an endoscopic technique 41.5 vs. 22.3%, P<0.01) and more patients were treated n day surgery (53.5 vs. 38.6%, P<0.01). Lastly, a decline n operations performed for recurrent IH in adults was bserved (10.9 vs. 13.3%, P<0.01). onclusion This study showed that most patients with IH n the Netherlands were treated according to the main ecommendations of the Dutch evidence-based guidelines

Ten-year audit of Lichtenstein hernioplasty under local anaesthesia performed by surgical residents

<p>Abstract</p> <p>Background</p> <p>To analyse in a prospective trial the long-term results of Lichtenstein hernioplasty performed by surgical trainees.</p> <p>Methods</p> <p>Training of tension-free Lichtenstein hernia operation was started in our ambulatory unit as an outpatient procedure under local anaesthesia in 1996. After performing 36 teaching operations together with residents and their supervising specialist, 281 patients were operated during 1996-2000 either by one senior consultant (n = 141) or by 12 surgical trainees (n = 140). After 10 years, 247 (88%) patients were available for the long-term assessment.</p> <p>Results</p> <p>After one month postoperatively, the rate of wound infections (consultant 1.1%, residents 0.7%) and hematomas (consultant 1.1%, residents 3.0%) were low and not related to surgeon's training level (ns). Only 6 (2.1%) clinically evident recurrences were found after 10 years: two after specialist repair and four after trainee repair (ns). Although one third of the patients reported some discomfort after 3 and 10 years, 93-95% of the patients were very satisfied with the operation, with no statistical difference between the surgeons.</p> <p>Conclusion</p> <p>Ambulatory open mesh repair under local anaesthesia was a safe operation and the long-term results were acceptable among the patients operated by surgical trainees.</p