Hernias: inguinal and incisional.

In the past decade hernia surgery has been challenged by two new technologies: by laparoscopy, which has attempted to change the traditional open operative techniques, and by prosthetic mesh, which has achieved much lower recurrence rates. The demand by health care providers for increasingly efficient and cost-effective surgery has resulted in modifications to pathways of care to encourage more widespread adoption of day case, outpatient surgery, and local anaesthesia. In addition, the UK National Institute for Clinical Excellence has recommended strategies for bilateral and recurrent hernias. Here, we discuss these strategies and review some neglected aspects of hernia management such as trusses, antibiotic cover, return to work and activity, and emergency surgery. Many of the principles of management apply equally to inguinal and incisional hernias. We recommend that the more difficult and complex of the procedures be referred to specialists.

[Trusses in the current management of hernia]. / Stellenwert der Bruchbandtherapie im Zeitalter moderner Hernienchirurgie.

To assess the frequency and reasons for truss prescription, we surveyed 437 general practitioners collaborating with the surgical department of the Kantonsspital Winterthur and all members of the Swiss Association of Orthotists. 59% of the general practitioners answered. For 85% of them trusses are obsolete. Based on the data of the orthotists, an estimated 1740 trusses are issued in Switzerland annually (250 per million population). In Switzerland approximately 16,000 hernia operations are performed annually. Therefore, 11% of hernia patients are supplied with a truss rather than referred for a consultant surgical opinion. Patients can be divided into groups, one that wears the truss only for a short time in order to delay surgery for medical or occupational reasons and another group, especially elderly patients, that wears the truss permanently. Poor hernia control and pain, hernia incarceration, or dissatisfaction with the uncomfortable truss are reasons for referral to a surgeon. In our personal experience with 14 patients, all judged their situation after the operation better than with the truss. Our study confirms that despite advances in hernia surgery and in the use of regional and local anesthesia trusses are often prescribed.