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Primary inguinal hernia repair in The Netherlands
M P Simons1, H F Hoitsma, F J Mullan
1Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
Objective:
To assess the operative methods used in Dutch surgical practice to repair the inguinal floor of the primary hernia.
Design:
Survey by questionnaire.
Setting:
University department of Surgery, The Netherlands.
Subjects:
All Dutch Surgeons.
Outcome Measures:
Answers to questions about the methods of repair used, specific surgical options, and materials. Comparison of training hospitals and district hospitals.
Results:
Replies were received from 145/155 departments (94%), but from only 448/774 individual surgeons (58%). 192 (43%) used one method alone (Bassini 71, Shouldice 49, McVay 36, Griffith 24 and others 12) and 256 (57%) of surgeons used combinations of 11 different methods. Only 9 used a prosthetic mesh and 7 laparoscopic repair. The Shouldice method was significantly more popular in training hospitals compared with non-training hospitals (36%) (71/199) compared with (20%) (48/249) (p < 0.05). There were many modifications to accepted methods. Only 78% (94/121) of surgeons who said that they did a standard shouldice repair incised the transversalis fascia. 64% (287) of surgeons said that they modified their technique to suit individual patients.
Conclusion:
In the Netherlands there is no standard technique of inguinal hernia repair.