A prospective study of 1000 hernias: results of the Plymouth Hernia Service.
BACKGROUND
A hernia service within a general hospital was prospectively evaluated to establish whether evidence-based protocols could deliver results comparable to those reported from specialist hernia clinics.


METHODS
Protocols were devised according to established models. With the support of a nurse specialist, 1015 patients with inguinal hernia were treated. Quality-of-life analysis was undertaken using the Short Form 36.


RESULTS
Patients ranged in age from 16-98 years (median, 56 years). Ambulatory day-case surgery was achieved in 820 patients (81%), with local anaesthesia in 891 (88%). Wound infection occurred in 10 patients (0.98%). Wound haematoma requiring surgical intervention occurred in three patients. Two patients formed wound seromas that settled spontaneously. One patient developed ischaemic orchitis resulting in testicular atrophy. At 5 days after operation, 91% of patients had returned to normal activity. At 1 year, 7 patients (0.7%) had pain sufficient to limit normal activity or employment. There were 8 recurrences (0.78%) at a median follow-up of 2.5 years. Quality-of-life was enhanced at 1 year postoperatively.


CONCLUSIONS
A protocol-driven hernia service within a general hospital can provide patient outcomes comparable to specialist hernia clinics.
Kingsnorth
A N
AN
Department of Surgery, Plymouth Postgraduate Medical School, Derriford Hospital, Plymouth, UK. andrew.kingsnorth@phnt.swest.nhs.uk
Bowley
D M G
DM
Porter
C
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000379:methods; D002985:Clinical Protocols; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000451:nursing / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D011229:Preanesthetic Medication; D011446:Prospective Studies; D011788:Quality of Life; D012008:Recurrence; D011795:Surveys and Questionnaires