Surgical management of inguinal hernia: retrospective cohort study in southeastern Scotland, 1985-2001

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Abstract
Introduction Inguinal hernia repair (IHR) is the most common general surgical procedure in the United Kingdom, with an estimated 80 000 cases a year. The past decade has seen an increase in the use of prosthetic mesh in open and laparoscopic hernia repair based on the premise of a tension-free repair.1 Conversely, although traditional repair with suturing using the Shouldice technique has been reported with low rates of recurrence, it is difficult to learn and often associated with high rates of recurrence when done in the wider community. Recent reports have indicated that laparoscopic repair is associated with less immediate postoperative pain and a faster return to normal activities, particularly for recurrent and bilateral hernias.2 Large case series indicate recurrence rates for open and laparoscopic mesh repairs as low as 0.2%,3 and randomised trials of open primary IHR, with follow up as short as two years, have consistently found fewer recurrences associated with using mesh than not,2 4 with similar results reported for recurrent hernias.5 We examined these changing trends in IHR in southeastern Scotland between 1985 and 2001. Footnotes This article was posted on bmj.com on 16 November 2004: http://bmj.com/cgi/doi/10.1136/bmj.38282.675556.F7 We thank Stephanie C Lewis for her help and advice with the statistics. Contributors HDEA and SP-B designed the study. HDEA collected the data. HDEA, SGN, and SP analysed the data and wrote the initial draft. SGN and HDEA revised the draft and prepared the final manuscript. HDEA is guarantor. Funding None. Competing interests None declared. Ethical approval Not needed.