Current practice of inguinal hernia repair at University of Cape Town affiliated hospitals: implications for training

Abstract

Background: Various inguinal hernia repair techniques exist, without one ‘single best’ option. Hernia society guidelines recommend laparoscopic repair  as one of its mainstays, provided surgeons are adequately trained. The current practice for hernia repair in South Africa as well as the surgical registrar  exposure to laparoscopic repair training is unknown.

Objectives: To quantify the current practice of inguinal hernia surgery in hospitals affiliated to the University of Cape Town (UCT) and to assess trainee  exposure to laparoscopic repair.

Methods: Adult patients who underwent inguinal hernia repair during the 12-month study period, at the four UCT affiliated hospitals were included.  Collected data parameters included age, gender, primary or recurrent, uni- or bilateral hernia, primary surgeon consultant or non-consultant, operative  time, and open or laparoscopic technique used.

Results: Three hundred and seventy-seven patients were included. Eighty-eight (23.2%) repairs were  performed laparoscopically, of which five (5.7%)  were converted to open. Non-consultants were present at 70/88 (79.5%) cases performed laparoscopically and were the primary surgeon at only 15  (17%). Laparoscopic repair was performed for 63.6% of bilateral versus 19.5% of unilateral hernias, 39.4% of recurrent hernias and 45% of hernias in  females. Two of the four hospitals in this study performed 81.8% of all laparoscopic repairs.

Conclusion: Inguinal hernias in our setting are predominantly repaired by open surgery. The likelihood of laparoscopic repair varies significantly  depending on which hospital the patient is referred to. Non-consultants have limited exposure to performing laparoscopic hernia repairs as the primary  surgeon.