Guidelines for inguinal hernia repair in everyday practice.
BACKGROUND
The Royal College of Surgeons of England published clinical guidelines for the management of groin hernia in adults in July 1993. We compared our indications, techniques, complications and outcome with these guidelines.


METHODS
A consecutive series of 440 patients who underwent a groin hernia repair from the 1 July 1994 to 30 July 1995 were studied retrospectively. Special consideration was given to the advantages and acceptance of day-case surgery. Confidential questionnaires were sent to all patients 6-12 months following surgery.


RESULTS
The majority of elective primary inguinal hernias (83%) were repaired by the open tension-free Lichtenstein mesh technique. Our selection criteria for day-case surgery included ASA I, age (< 65 years) and social situation; 56% underwent an operation on a day-case basis. Including in-patients discharged within 24 h following operation, this proportion of 'day-cases' increased to 72.5%. Less complications occurred in the day-case group (P = 0.018). However, this difference may be caused by incomplete reporting of complications in the day-case group. There were no significant differences in patients' satisfaction, postoperative attendance for medical advice or time back to work between the day-case and in-patient group.


CONCLUSIONS
The guidelines need to be reviewed. The Lichtenstein repair offers an excellent and simple technique for hernia repair as a day-case procedure. Our results suggest that the number of hernia repairs performed as a day-case could substantially be increased to more than the recommended 30%. Time off work is mainly influenced by the advice given by GPs and surgeons. Reducing time off work by giving more appropriate recommendations and increasing the number of day-case surgery cases could significantly reduce the costs of health-care.
Metzger
J
J
Surgical Department, Frimley Park Hospital, Camberley, Surrey, UK. metzgerj@bluewin.ch
Lutz
N
N
Laidlaw
I
I
D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000706:statistics & numerical data; D000758:Anesthesia / Q000379:methods; D013505:Digestive System Surgical Procedures / Q000379:methods; D004739:England; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014850:Waiting Lists