Improving management of women presenting with groin hernias at royal devon and exeter hospital (RD&E)

ABSTRACT

Aim: Determine the percentage of women with groin hernia undergoing laparoscopic repair at RD&E hospital and if it was offered during clinic visit. Background: The lifetime risk of groin hernia in women is 3-5.8%. The incidence of missed femoral hernia at re-operation after open repair in women is 41%. The HerniaSurge group has recommended laparoscopic repair of all groin hernias in women as it offers opportunity to identify all types of groin hernias and reduces post-operative pain and recurrence. Method: All female patients undergoing groin hernia surgery at RD&E hospital from 1 Feb 2018-31 Jan 2020 were identified. Patients undergoing surgery after this period were not included as the surgical practice was changing due to COVID-19 pandemic. Electronic patient records including clinic letters, operative notes, radiology reports and follow up letters were reviewed. Results: 117 female patients undergoing groin hernia repair were identified. During clinic visit, rationale for laparoscopic surgery was documented only in 29/117 while discussion regarding material risks of surgery was documented in 51/117. Only 41/117 (35%) patients underwent laparoscopic hernia repair. Conclusion and second cycle The current practice at RD&E requires improvements in terms of documentation of material risks associated with groin hernia repair and offering laparoscopic repair for women with groin hernias. For the next cycle, we aim to present at the local audit meeting and then collect further data to evaluate improvements in practice. We also aim to create a standardised electronic clinic letter and operative note format to bring uniformity of care.