Primary inguinal hernia repair in 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.