Ten-year Audit of Lichtenstein Hernioplasty under Local Anaesthesia Performed by Surgical Residents

Hannu Paajanen; Riitta Varjo


BMC Surg 

In This Article


Inguinal hernias occur in about 15% of adult men and hernioplasty is the most common surgical procedure performed by general surgeons.[1] Approximately 11 000 inguinal hernioplasties are performed each year in Finland, over 80 000 operations in England and over 800 000 in the United States.[1–3] In Scandinavian countries, the majority of groin hernias are currently operated in ambulatory surgical units. About 20% of groin hernia repairs are done due to recurrences and only 4% as emergency.[1–3] The economical impact of groin hernia surgery is high on the health care system.

There is strong evidence that surgeon's case volume, hospital volume and specialisation improve the outcome of many major surgical procedures, such as coronary artery bypass, gastrectomy, esophagectomy, pancreaticoduodenectomy and rectal cancer surgery.[4,5] The role of specialist centers in more common surgical operations, such as colon resections or inguinal hernioplasties, is not so clear.[3,6] Although inguinal hernioplasty is one of the first operations performed by surgical residents, only few studies have compared the immediate results between residents and their consultant.[7–11] The reliable recurrence rate of inguinal hernioplasty needs over 5 years of follow-up, and there are not available such long-term studies between residents and attending surgeons so far.

Lichtenstein hernioplasty is a tension-free technique, which uses polypropylene mesh to support the inguinal muscular layers.[12] Its learning curve may be shorter than traditional groin hernioplasties, and therefore Lichtenstein procedure has rapidly increased as a primary operation in inguinal hernia in many countries. Under local anaesthesia, it can be performed as a rapid outpatient procedure with cost savings.[13] The present study was designed as a quality control audit in the surgical training program for this common surgical procedure. The main interest was whether well-trained surgical residents are able to perform Lichtenstein operation with an acceptable immediate and long-term outcome compared to the experienced specialist in hernia surgery.