Hunterian Lecture. Hernia surgery: from guidelines to clinical practice.
BACKGROUND
Over the last 30 years, hernia surgery has developed into an evidence-based practice assisted by the development of guidelines.


METHODS
Prior to 1993, best practice in the UK was a nylon darn repair under general anaesthesia as an inpatient with prolonged recovery. The publication of The Royal College of Surgeons of England (RCSE) Guidelines on Groin Hernia Repair stimulated debate and coincided with the introduction of mesh hernioplasty and laparoscopic techniques. Further evolution of hernia management has occurred to enable the production of the European Hernia Society (EHS) guidelines in 2008.


RESULTS
The EHS guidelines cover all aspects of abdominal wall surgery including: indications for operation; investigations; organising surgical care; techniques; local anaesthesia; after-care, complications and outcome; and information for patients.


CONCLUSIONS
Surgeons have many choices when selecting an appropriate hernia operation for an individual patient. The EHS guidelines provide a basis for this decision-making.
Kingsnorth
Andrew N
AN
Plymouth Hernia Service, Peninsula Medical School, Derriford Hospital, Plymouth, UK. andrew.kingsnorth@phnt.swest.nhs.uk
D000772:Anesthesia, Local; D004638:Emergency Treatment; D059685:Herniorrhaphy; D006801:Humans; D010353:Patient Education as Topic; D011182:Postoperative Care; D017410:Practice Guidelines as Topic; D011364:Professional Practice; D013526:Surgical Mesh