title: NICE guidance and current practise of recurrent and bilateral groin hernia repair by Scottish surgeons.
abstract: BACKGROUND
  NICE (National Institute of Health and Clinical Excellence) in England recommended laparoscopic repair for recurrent and bilateral groin hernias in 2004. The aims of this survey were to evaluate the current practise of bilateral and recurrent inguinal hernia surgery in Scotland and surgeons' views on the perceived need for training in laparoscopic inguinal hernia repair (LIHR).
  
  
  METHODS
  A postal questionnaire was sent to Scottish consultant surgeons included in the Scottish Audit of Surgical Audit database 2007, asking about their current practice of primary, recurrent and bilateral inguinal hernia surgery. A response was considered valid if the surgeon performed groin hernia surgery; further analysis was based on this group. Those who did not offer LIHR were asked to comment on the possible reasons, and also the perceived need for training in laparoscopic hernia surgery. Only valid responses were stored on Microsoft Excel (Microsoft Corporation, USA) and analysed with SPSS software version 13.0 (SPSS, Chicago, Illinois).
  
  
  RESULTS
  Postal questionnaires were sent to 301 surgeons and the overall all response rate was 174/301 (57.8%). A valid response was received from 124 of 174 (71.2%) surgeons and analysed further. Open Lichtenstein's repair seems to be the most common inguinal hernia repair. Laparoscopic surgery was not performed for 26.6 and 31.5% of recurrent and bilateral inguinal hernia, respectively. About 15% of surgeons replied that an LIHR service was not available in their base hospital. Lack of training, financial constraints, and insufficient evidence were thought to be the main reasons for low uptake of LIHR. About 80% of respondents wished to attend hands-on training in hernia surgery.
  
  
  CONCLUSIONS
  Current practice by Scottish surgeons showed that one in three surgeons did not offer LIHR for bilateral and recurrent inguinal hernia as recommended by NICE. There is a clear need for training in LIHR.
authors.affiliation: Department of Surgery (Ward 106), The Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK. i.shaikh@nhs.net
authors.forename: I
authors.initials: I
authors.lastname: Shaikh
authors.forename: B
authors.initials: B
authors.lastname: Olabi
authors.forename: V M Y
authors.initials: VM
authors.lastname: Wong
authors.forename: S J
authors.initials: SJ
authors.lastname: Nixon
authors.forename: S
authors.initials: S
authors.lastname: Kumar
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D013502:General Surgery; D019983:Guideline Adherence; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000193:education* / Q000706:statistics & numerical data; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012008:Recurrence; D012606:Scotland; D011795:Surveys and Questionnaires