A United Kingdom survey of surgical technique and handling practice of inguinal canal structures during hernia surgery

Background. Recent trials have assessed the impact of elective nerve division on patient outcome after inguinal herniorrhaphy. The aim of this study was to establish UK surgical practice of handling of structures in the inguinal canal during herniorrhaphy.
Methods. A cross-sectional survey of all Fellows (n = 1113) of the Association of Surgeons of Great Britain and Ireland (ASGBI) was performed. The main outcomes were to determine method of inguinal hernia repair and routine practice for intra-operative handling of structures in the inguinal canal.
Results. A total of 852 (77 %) questionnaires were returned, of which 784 (92 %) surgeons performed inguinal herniorrhaphy. Approximately two-thirds (63 %) of responding surgeons performed less than 50 procedures per annum and 37 % conducted more than 50 procedures annually. Mesh was the preferred method used by 90 % of surgeons; 6 % used non-mesh, and 4 % used other (laparoscopic) methods. Routine practice in relation to the inguinal structures varied by volume of hernia surgery; surgeons who conducted more than 50 procedures annually were more likely to visualize and preserve inguinal nerve structures. However, inconsistency in the answers suggested confusion over anatomy.
Conclusion. This is the first UK survey to investigate method of hernia repair and usual handling practice of inguinal canal structures. There was wide acceptance of the use of mesh in inguinal hernia repair, with the majority of UK surgeons favoring an open approach. Surgeons performing high volumes of herniorrhaphy were more likely to preserve, rather than transect, inguinal nerve structures. This variation in practice may confound assessment of long-term neuralgia and other post-herniorrhaphy pain syndromes.