Primary inguinal hernia repair in The Netherlands.

ABSTRACT

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.