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Published in: BMC Surgery 1/2010

Open Access 01-12-2010 | Research article

Ten-year audit of Lichtenstein hernioplasty under local anaesthesia performed by surgical residents

Authors: Hannu Paajanen, Riitta Varjo

Published in: BMC Surgery | Issue 1/2010

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Abstract

Background

To analyse in a prospective trial the long-term results of Lichtenstein hernioplasty performed by surgical trainees.

Methods

Training of tension-free Lichtenstein hernia operation was started in our ambulatory unit as an outpatient procedure under local anaesthesia in 1996. After performing 36 teaching operations together with residents and their supervising specialist, 281 patients were operated during 1996-2000 either by one senior consultant (n = 141) or by 12 surgical trainees (n = 140). After 10 years, 247 (88%) patients were available for the long-term assessment.

Results

After one month postoperatively, the rate of wound infections (consultant 1.1%, residents 0.7%) and hematomas (consultant 1.1%, residents 3.0%) were low and not related to surgeon's training level (ns). Only 6 (2.1%) clinically evident recurrences were found after 10 years: two after specialist repair and four after trainee repair (ns). Although one third of the patients reported some discomfort after 3 and 10 years, 93-95% of the patients were very satisfied with the operation, with no statistical difference between the surgeons.

Conclusion

Ambulatory open mesh repair under local anaesthesia was a safe operation and the long-term results were acceptable among the patients operated by surgical trainees.
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Literature
1.
go back to reference Cheek CM, Black NA, Devlin HB: Groin hernia surgery: a systematic review. Ann R Coll Surg Engl. 1998, 80 (Suppl 1): S1-S20.PubMed Cheek CM, Black NA, Devlin HB: Groin hernia surgery: a systematic review. Ann R Coll Surg Engl. 1998, 80 (Suppl 1): S1-S20.PubMed
2.
go back to reference Paajanen H, Scheinin T, Vironen J: Nationwide analysis of complications related to inguinal hernia surgery in Finland: a 5-year register study of 55 000 operations. Am J Surg. 2010, 199: 746-51. 10.1016/j.amjsurg.2009.04.018.CrossRefPubMed Paajanen H, Scheinin T, Vironen J: Nationwide analysis of complications related to inguinal hernia surgery in Finland: a 5-year register study of 55 000 operations. Am J Surg. 2010, 199: 746-51. 10.1016/j.amjsurg.2009.04.018.CrossRefPubMed
3.
go back to reference Bay-Nielsen M, Kehlet H, Strand L: Quality assessment of 26304 herniorrhaphies in Denmark: a prospective nationwide study. Lancet. 2001, 358: 1124-28. 10.1016/S0140-6736(01)06251-1.CrossRefPubMed Bay-Nielsen M, Kehlet H, Strand L: Quality assessment of 26304 herniorrhaphies in Denmark: a prospective nationwide study. Lancet. 2001, 358: 1124-28. 10.1016/S0140-6736(01)06251-1.CrossRefPubMed
6.
go back to reference Singh KK, Aitken RJ: Outcome in patients with colorectal cancer managed by surgical trainees. Br J Surg. 1999, 86: 1332-5. 10.1046/j.1365-2168.1999.01234.x.CrossRefPubMed Singh KK, Aitken RJ: Outcome in patients with colorectal cancer managed by surgical trainees. Br J Surg. 1999, 86: 1332-5. 10.1046/j.1365-2168.1999.01234.x.CrossRefPubMed
7.
go back to reference Neumayer LA, Gawande AA, Wang J: Proficiency of surgeons in inguinal hernia repair. Effect of experience and age. Ann Surg. 2005, 242: 344-352.PubMedPubMedCentral Neumayer LA, Gawande AA, Wang J: Proficiency of surgeons in inguinal hernia repair. Effect of experience and age. Ann Surg. 2005, 242: 344-352.PubMedPubMedCentral
8.
go back to reference Cueto Rozon R, De Baerdemacker Y, Polliand C, Champault G: Surgical training and inguinal hernia repair. Ann Surg. 2006, 131: 311-5. Cueto Rozon R, De Baerdemacker Y, Polliand C, Champault G: Surgical training and inguinal hernia repair. Ann Surg. 2006, 131: 311-5.
9.
go back to reference Danielsson P, Isacson S, Hansen MV: Randomised study of Lichtenstein compared with Shouldice inguinal hernia repair by surgeons in training. Eur J Surg. 1999, 165: 49-53.CrossRefPubMed Danielsson P, Isacson S, Hansen MV: Randomised study of Lichtenstein compared with Shouldice inguinal hernia repair by surgeons in training. Eur J Surg. 1999, 165: 49-53.CrossRefPubMed
10.
go back to reference Miedema BW, Ibrahim SM, Davis BD, Koivunen DG: A Prospective trial of primary inguinal hernia repair by surgical trainees. Hernia. 2004, 8: 28-32. 10.1007/s10029-003-0151-z.CrossRefPubMed Miedema BW, Ibrahim SM, Davis BD, Koivunen DG: A Prospective trial of primary inguinal hernia repair by surgical trainees. Hernia. 2004, 8: 28-32. 10.1007/s10029-003-0151-z.CrossRefPubMed
11.
go back to reference Wilkiemeyer M, Pappas TN, Giobbie-Hurder A: Does resident post graduate year influence the outcomes of inguinal hernia repair?. Ann Surg. 2005, 241: 879-884. 10.1097/01.sla.0000164076.82559.72.CrossRefPubMedPubMedCentral Wilkiemeyer M, Pappas TN, Giobbie-Hurder A: Does resident post graduate year influence the outcomes of inguinal hernia repair?. Ann Surg. 2005, 241: 879-884. 10.1097/01.sla.0000164076.82559.72.CrossRefPubMedPubMedCentral
12.
go back to reference Lichtenstein IL, Shulman AG, Amid PK, Montllor MM: The tension-free hernioplasty. Am J Surg. 1989, 157: 188-191. 10.1016/0002-9610(89)90526-6.CrossRefPubMed Lichtenstein IL, Shulman AG, Amid PK, Montllor MM: The tension-free hernioplasty. Am J Surg. 1989, 157: 188-191. 10.1016/0002-9610(89)90526-6.CrossRefPubMed
13.
go back to reference Van Veen RN, Mahabier C, Dawson I: Spinal or local anesthesia in lichtenstein hernia repair: a randomized controlled trial. Ann Surg. 2008, 247: 428-33. 10.1097/SLA.0b013e318165b0ff.CrossRefPubMed Van Veen RN, Mahabier C, Dawson I: Spinal or local anesthesia in lichtenstein hernia repair: a randomized controlled trial. Ann Surg. 2008, 247: 428-33. 10.1097/SLA.0b013e318165b0ff.CrossRefPubMed
14.
go back to reference Paajanen H: Lichtenstein inguinal herniorraphy under local infiltration anaesthesia as rapid outpatient procedure. Ann Chir Gyn. 2001, 215: 51-54. Paajanen H: Lichtenstein inguinal herniorraphy under local infiltration anaesthesia as rapid outpatient procedure. Ann Chir Gyn. 2001, 215: 51-54.
15.
go back to reference Amid PK, Shulman AG, Lichtenstein IL: Critical scrutiny of the open "tension-free" hernioplasty. Am J Surg. 1993, 165: 369-71. 10.1016/S0002-9610(05)80847-5.CrossRefPubMed Amid PK, Shulman AG, Lichtenstein IL: Critical scrutiny of the open "tension-free" hernioplasty. Am J Surg. 1993, 165: 369-71. 10.1016/S0002-9610(05)80847-5.CrossRefPubMed
16.
go back to reference Bay-Nielsen M, Perkins FM, Kehlet H: Pain and functional impairment 1 year after inguinal herniorraphy: A nationwide questionnaire study. Ann Surg. 2001, 233: 1-7. 10.1097/00000658-200101000-00001.CrossRefPubMedPubMedCentral Bay-Nielsen M, Perkins FM, Kehlet H: Pain and functional impairment 1 year after inguinal herniorraphy: A nationwide questionnaire study. Ann Surg. 2001, 233: 1-7. 10.1097/00000658-200101000-00001.CrossRefPubMedPubMedCentral
17.
go back to reference Rutkow IM, Robbins AW: "tension-free" inguinal herniorraphy: A preliminary report on the "mesh plug" technique. Surgery. 1993, 114: 3-8.PubMed Rutkow IM, Robbins AW: "tension-free" inguinal herniorraphy: A preliminary report on the "mesh plug" technique. Surgery. 1993, 114: 3-8.PubMed
18.
go back to reference Wantz GE: Experience with the tension-free hernioplasty for primary inguinal hernias in men. J Am Coll Surg. 1996, 183: 351-6.PubMed Wantz GE: Experience with the tension-free hernioplasty for primary inguinal hernias in men. J Am Coll Surg. 1996, 183: 351-6.PubMed
19.
go back to reference Koukourou A, Lyon W, Rice J, Wattchow DA: Prospective randomized trial of polypropylenene mesh compared with nylon darn in inguinal hernia repair. Br J Surg. 2001, 88: 931-4. 10.1046/j.0007-1323.2001.01818.x.CrossRefPubMed Koukourou A, Lyon W, Rice J, Wattchow DA: Prospective randomized trial of polypropylenene mesh compared with nylon darn in inguinal hernia repair. Br J Surg. 2001, 88: 931-4. 10.1046/j.0007-1323.2001.01818.x.CrossRefPubMed
20.
go back to reference Friis E, Lindahl F: The tension-free hernioplasty in a randomized trial. Am J Surg. 1996, 172: 315-319. 10.1016/S0002-9610(96)00188-2.CrossRefPubMed Friis E, Lindahl F: The tension-free hernioplasty in a randomized trial. Am J Surg. 1996, 172: 315-319. 10.1016/S0002-9610(96)00188-2.CrossRefPubMed
21.
go back to reference Shulman AG, Amid PK, Lichtenstein IL: A survey of non-expert surgeons using the open tension-free mesh patch repair for primary inguinal hernias. Int Surg. 1995, 80: 35-6.PubMed Shulman AG, Amid PK, Lichtenstein IL: A survey of non-expert surgeons using the open tension-free mesh patch repair for primary inguinal hernias. Int Surg. 1995, 80: 35-6.PubMed
22.
go back to reference Poobalan AS, Bruce J, King PM: Chronic pain and quality of life following open inguinal hernia repair. Br J Surg. 2001, 88: 1122-6. 10.1046/j.0007-1323.2001.01828.x.CrossRefPubMed Poobalan AS, Bruce J, King PM: Chronic pain and quality of life following open inguinal hernia repair. Br J Surg. 2001, 88: 1122-6. 10.1046/j.0007-1323.2001.01828.x.CrossRefPubMed
23.
go back to reference Aasvang EK, Kehlet H: The effect of mesh removal and selective neurectomy on persistent postherniotomy pain. Ann Surg. 2009, 249: 327-34. 10.1097/SLA.0b013e31818eec49.CrossRefPubMed Aasvang EK, Kehlet H: The effect of mesh removal and selective neurectomy on persistent postherniotomy pain. Ann Surg. 2009, 249: 327-34. 10.1097/SLA.0b013e31818eec49.CrossRefPubMed
24.
go back to reference Smeds S, Löfström L, Eriksson O: Influence of nerve identification and the resection of nerves 'at risk' on postoperative pain in open inguinal hernia repair. Hernia. 2010, 14: 265-70. 10.1007/s10029-010-0632-9.CrossRefPubMed Smeds S, Löfström L, Eriksson O: Influence of nerve identification and the resection of nerves 'at risk' on postoperative pain in open inguinal hernia repair. Hernia. 2010, 14: 265-70. 10.1007/s10029-010-0632-9.CrossRefPubMed
25.
go back to reference Simons MP, Aufenacker T, Bay-Nielsen M: European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009, 13: 343-403. 10.1007/s10029-009-0529-7.CrossRefPubMedPubMedCentral Simons MP, Aufenacker T, Bay-Nielsen M: European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009, 13: 343-403. 10.1007/s10029-009-0529-7.CrossRefPubMedPubMedCentral
Metadata
Title
Ten-year audit of Lichtenstein hernioplasty under local anaesthesia performed by surgical residents
Authors
Hannu Paajanen
Riitta Varjo
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Surgery / Issue 1/2010
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/1471-2482-10-24

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