Trends in the management of inguinal hernia in Karachi, Pakistan: a survey of practice patterns

The study was conducted to identify and document the various aspects of elective inguinal hernia repair performed by general surgeons working in the different university hospitals of Karachi, Pakistan.

This questionnaire-based survey, carried out over a two-year period, involved 84 general surgeons of Karachi. The respondents were divided into groups and comparative analysis was carried out.

65 respondents (77.4 percent) were male and 19 (22.6 percent) were female. Mean years and standard deviation since post graduation were 7.7 and 7.3 years, respectively. 60 respondents (71.4 percent) reported the routine use of prophylactic antibiotics in all inguinal hernia repairs. 34 respondents (40.5 percent) quoted "spinal anaesthesia" as their preferred type of anaesthesia, 46 respondents (54.8 percent) chose to perform the procedure as a day case, and 49 respondents (58.3 percent) reported mesh repair as their preferred type of repair. 60 respondents (71.4 percent) did not recommend the laparoscopic approach to hernia repair. Surgeons associated with private hospitals were found more likely to choose mesh as their preferred method of inguinal hernia repair (p-value is 0.007), but less likely to use prophylactic antibiotics (p-value is 0.05) and respondents with more than ten years of postgraduate experience were found more likely to perform hernia repairs on an inpatient basis (p-value is 0.045).

Various aspects of management of inguinal hernias are still determined by the preference of the operating surgeon. Day case management of hernia repairs, routine use of prophylactic antibiotics, use of mesh and open repair of hernias were the practice of the majority of surgeons, although differences were noted in specific groups of surgeons.