Inguinal herniorrhaphy. Reduced morbidity by service standardization
M. Deysine, R. C. Grimson and H. S. Soroff
Department of Surgery, Northport Veterans Administration Medical Center, NY.
To ascertain if service specialization and procedure standardization would
improve the complication rate of inguinal herniorrhaphy, the results of all
inguinal herniorrhaphies performed during a 3-year period by
board-certified general surgeons who also performed a variety of other
procedures common to the field of general surgery, assisted by general
surgical residents (group B, 390 patients), were compared in the same
institution with the results of inguinal herniorrhaphy when performed
during 3 years under protocol by a Hernia Service directed by a senior
faculty member assisted by junior surgical residents (group C, 442
patients). Group B patients had essentially no follow-up until they
reappeared for care at the Hernia Service, whereas patients in group C
achieved an 82% 7-year follow-up. The infection and recurrence rates of
group C patients (0.45% and 0.9%, respectively) were significantly better
than those of group B patients (5.9% and 4.6%, respectively). These results
suggest that in our institution, the concentration of patients with hernias
in a hernia service, manned by a specialized surgeon, produced better
short- and long-term results than those obtained by general surgeons not
dedicated to the field of hernia repair. Further studies will be necessary
to confirm these findings.