title: Inguinal hernia surgery in The Netherlands: are patients treated according to the guidelines?
abstract: OBJECTIVE
  In 2003, a dedicated Dutch committee developed evidence-based guidelines for the treatment of inguinal hernia (IH) in children and adults. The aim of this study was to describe trends in hernia care before and after the publication of the guidelines on IH surgery in The Netherlands.
  
  
  METHODS
  Originally, a retrospective baseline analysis of IH surgery in 90 Dutch hospitals was performed among patients treated for IH in 2001. The results of this baseline analysis were compared with a recently performed second analysis of patients treated for IH in 2005.
  
  
  RESULTS
  In children <4 years of age, the study showed a significant decrease of contralateral explorations. In adults, the study showed that significantly more patients were treated with a mesh-based repair in 2005 (95.9 vs. 78.8%, P < 0.01). Moreover, there was an increase of patients with bilateral hernia treated with an endoscopic technique (41.5 vs. 22.3%, P < 0.01) and more patients were treated in day surgery (53.5 vs. 38.6%, P < 0.01). Lastly, a decline in operations performed for recurrent IH in adults was observed (10.9 vs. 13.3%, P < 0.01).
  
  
  CONCLUSIONS
  This study showed that most patients with IH in The Netherlands were treated according to the main recommendations of the Dutch evidence-based guidelines.
authors.affiliation: Department of Surgery, Westfries Gasthuis, P.O. Box 600, 1620 AR, Hoorn, The Netherlands. dhdelange@hotmail.com
authors.forename: D H
authors.initials: DH
authors.lastname: de Lange
authors.forename: M
authors.initials: M
authors.lastname: Kreeft
authors.forename: G H
authors.initials: GH
authors.lastname: van Ramshorst
authors.forename: T J
authors.initials: TJ
authors.lastname: Aufenacker
authors.forename: J A
authors.initials: JA
authors.lastname: Rauwerda
authors.forename: M P
authors.initials: MP
authors.lastname: Simons
mesh_terms: D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006552:Hernia, Inguinal / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh