National Survey on the management of inguinal hernia in Spain. Comparison of results with the international guide of the Hernia Surge Group

Abstract

Introduction: Inguinal hernia surgery is the most common procedure in general surgery. Experts from several international scientific societies created in 2018 "the International guidelines for groin hernia management", to improve treatment and results of this pathology. The adherence to these recommendations is highly variable. Objective: To establish the Spanish reality in the management of this pathology, and evaluate the adherence to the Guide's recommendations. Method: Survey designed ad hoc; with 29 multiple-answer questions following the most important guide information. They were fulfilled between June and December 2019 through email by an in-chain format and face-to-face in four general surgeon meetings. Results: 173 surveys were collected, representative of Spain's geography. 76 % of senior surgeons participated; less than half are engaged normally in abdominal wall surgery. Outpatient system is the usual, although only 10 % of cases were under local anesthesia. Laparoscopic approach was rare; indicated for bilateral hernia and hernia recurrence. 94 % believe that laparoscopic approach won't become the standard for inguinal hernia management. Contrary to recommendations, plug-repair is continuously used (38 %) and self-adhesive meshes (59 %) were well evaluated. The majority believe to have good results, but subjectively, because 78 % do not know the real statistics due to a lack of studies. The Hernia Surge Guide has limited diffusions in our environment: 47 % don't know it and only 10 % consider it as reference. Conclusions: This Guide is poorly known among Spanish national surgeons, although they showed interest in updating. The reticence to the laparoscopic approach stands out. Most follow the recommendations in open surgery, but only a minority audits their own results.