Impact of institutional hernia programme on guideline conformity of surgical approach and mode of anesthesia for inguinal hernia repair and analysis of the outcomes

AIM: The objective of this study is to elucidate the guideline conformity of surgical approach and mode of anesthesia for inguinal hernia (IH) treatment together with analysis of the outcomes on the implementation of “guideline-based treatment for IH” as a part of institutional hernia programme (IHP) in a single surgical unit. METHODS: This is a retrospective analysis of health records of the male patients who underwent surgery for IH at a single surgical center, during the period May 1, 2015–May 1, 2016, where the surgeons adhered to “guideline-based treatment for IH.” Health records of the patients who underwent surgery for IH from May 1, 2014, to April 30, 2015, too were collected for comparison. Data related to demographics, surgical approach, mode of anesthesia, and surgical complication were analyzed. RESULTS: Sixty-two male patients with a mean age of 33.5 (range: 22–54) years and 99 male patients with a mean age of 32.84 (range: 22–70) years have undergone IH repair before the IHP and during the IHP, respectively. The overall use of local anesthesia (LA) for unilateral IH had increased from 3.5% (n = 2) to 83.12% (n = 65) (P ≤ 0.0001) during IHP. The laparoscopic approach was used in 83.34% of patients with bilateral IH during IHP (P = 0.0007). All (n = 3) the recurrences following open repair were attempted to treat laparoscopically during the IHP. Laparoscopic approach was not utilized to treat IH before the IHP. Overall recurrence rate increased to 4.04 (n = 4) during IHP from 0% (P = 0.299). Overall complication rate increased from 3.22% (n = 2) to 8.08% (n = 8) during IHP (P = 0.319). CONCLUSION: Surgical approach and mode of anesthesia for IH treatment showed high conformity with the guidelines during the IHP. The increased recurrence and complication rates were statistically insignificant.