Mesh hernioplasty: surgeons' training ground?

ABSTRACT

To clinically evaluate the outcome of Inguinal Hernioplasty in terms haematoma, wound infection and recurrence, with special reference to surgery done by trainee surgeons. Case control study with prospective data collection, conducted from Sep. 2005 to August 2006. Surgical Unit two, Civil Hospital, Karacho. All male patients above 30 years of age with Inguinal hernia were included in the study. Patients presenting in emergency and those with age less than 30 years were excluded, as they did not undergo Mesh Hernioplasty. Patients with symptoms like chronic cough and constipation, and those with conditions like anaemia, diabetes and hypertension were optimized before surgery. Anaesthesia fitness was taken after necessary investigations. Patients were mostly operated under Regional [Spinal] anaesthesia. Two doses of a first generation cephalosporin or co-amoxiclav were used as a prophylactic antibiotic. Data was collected on a pre-designed proforma; record was also duplicated on the computer in the SPSS Version 10. Out patient follow-up was done for 6 months as a minimum. A total of 75 males with 78 inguinal hernias were operated during the study period; three patients had bilateral hernia. Sixty five percent of our patients had hernia on the right side and 31% on the left side, while 4% were bilateral. The ages of the patients ranged from 30 to 81 years; majority [72%] were under the age of 60 years. Sixty percent of the patients were manual workers. Sixty nine [88.5%] inguinal hernias were reducible and 9 [11.5%] irreducible; 6[7.7%] were recurrent. Trainee surgeons did 70% of the operations. Haematoma occurred in five cases, seroma in nine, urinary retention in four, wound infection in four and recurrence in one case. No mortality occurred during the study. In our set-up Mesh Hernioplasty has proven to be effective with low complication and recurrence rates. It is easily learnt by trainee surgeons. Early ambulation should be the aim. Cost of the mesh is a minor stumbling block, but the long term benefits of this hernia repair makes it the benchmark for all