ADULT HERNIA SURGERY IN WALES REVISITED - IMPACT OF THE GUIDELINES OFTHE ROYAL-COLLEGE-OF-SURGEONS OF ENGLAND

This study investigated the impact of the guidelines of The Royal Coll ege of Surgeons of England on the practice of hernia surgery in Wales. This was assessed by means of a postal survey to all consultant gener al surgeons in Wales in 1996-1997. The areas covered were: awareness o f the guidelines of The Royal College of Surgeons of England and the i mpact of such guidelines on their practice, attendance at hernia cours es, operative technique, materials used for repair and skin suture, pr oportion of day case hernias, length of inpatient stay, thromboembolic (TE) prophylaxis and postoperative advice to patients with regard to light work, heavy work and sport. In all, 79 replies were received (85 %). Almost all the surgeons had read the guidelines; this changed the practice of 20% of respondents but did not in 32%. A further 48% did n ot answer the question. In contrast with our 1993 survey results, in W ales there is now a uniform surgical management of adult inguinal hern ias: the most common operation is the Liechtenstein, with monofilament non-absorbable suture to secure the mesh, followed by the Shouldice r epair. The Bassini and inguinal darn operations are becoming much less common and none now uses braided or absorbable sutures for the repair . Skin closure is still rather variable, with only 58% of respondents adhering to the recommended absorbable subcuticular suture. Postoperat ive advice is now uniform and in accordance with the guidelines. A tre nd towards more TE prophylaxis and more day case hernia surgery is als o seen.