Inguinal hernia surgery in The Netherlands: a baseline study before the introduction of the Dutch Guidelines.
BACKGROUND
In 2003 the Dutch Guidelines for treatment of inguinal hernia (IH) were published. For treatment of IH in adults, the evidence-based guidelines recommend the use of a mesh repair technique. In order to be able to evaluate the effects of these guidelines, a baseline analysis of inguinal hernia surgery before the introduction of these guidelines had to be performed. The second analysis will be performed two years (January-March 2005) after the publication of the Guidelines.


OBJECTIVE
To make an inventory of IH surgery in the Netherlands, before the introduction of guidelines for IH treatment, to serve as a baseline for future evaluation of the impact of the implementation of these guidelines.


METHODS
A retrospective descriptive study was performed in 2003 using patient and operation charts including IH repairs performed in The Netherlands over a three-month period (January-March 2001).


RESULTS
97/133 (73%) hospitals cooperated with the study, generating data from a total of 4386 IH in 3979 patients (3284 adults, 695 children). Mesh techniques were used in 2839 (78%) adult inguinal hernias while 800 (22%) patients were treated with non-mesh techniques. 484 (14.7%) adult patients were operated on during the study period for a recurrent hernia from previous years. Early recurrence (<1 year) occurred in 2.2% of all patients. Wound infection was documented in 0.8% of all IH. The mortality rate was 0.1%. 1257 of the 3284 (38.3%) adults, and 566 of the 695 children (81.4%), were operated on in ambulatory care.


CONCLUSIONS
In the episode prior to implementation of the Dutch evidence-based Guidelines for treatment of inguinal hernia, 2839 (78%) adult patients were treated with mesh repair and 484 (13.3%) patients were treated for a recurrent hernia.
de Lange
D H
DH
Department of Surgery, Slotervaart Ziekenhuis, Louwesweg 6, 1066 EC, Amsterdam, The Netherlands.
Aufenacker
Th J
TJ
Roest
M
M
Simmermacher
R K J
RK
Gouma
D J
DJ
Simons
M P
MP
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002648:Child; D019317:Evidence-Based Medicine; D005260:Female; D006552:Hernia, Inguinal / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000592:standards* / Q000706:statistics & numerical data; D007813:Laparotomy / Q000592:standards* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D017410:Practice Guidelines as Topic; D011336:Probability; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D013526:Surgical Mesh; D016896:Treatment Outcome
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