An Audit of Inguinal Hernia Repairs- a PESSI Experience

Abstract

Introduction: Inguinal hernia: the most commonly performed operation in general surgical practice. Advanced techniques like open and laparoscopic mesh repairs are the preferred operations these days. Social Security Health Care System working under PESSI Punjab Employees Social Security Institute) provides a closed system of surveillance of ‘operated patients. Patients once operated are on record and present for follow up to the relevant surgical unit for over a period of years, unlike the government Hospitals, where patients are lost to follow up once they get discharged. Study design: Retrospective study. Place and duration of study: Department of Surgery, Punjab Employees Social Security Hospital, Ferozepur Road. Lahore from January 2001 to December, 2006. Objective: To establish the reliability of non-mesh tissue repair technique as a primary procedure in inguinal hernia. Results: About 500 patients underwent surgery for inguinal hernias. In those with primary inguinal hernia, tissue repair techniques (plication of transversalis fascia and darning of posterior wall with prolene No.1) were used while in those patients who had recurrent inguinal hernias, either tissue repair or mesh repair was carried out. Tissue repair techniques gave us excellent results with a recurrence rate of 0.4% (2/500) over a mean follow up period of 4.5 years. Conclusion: The reliability of inguinal hernia repair technique primarily with a mesh is not established whereas the old traditional tissue repair techniques have decades of experience to justify their reliability as far as recurrence is concerned.