3 National Survey of Consultant and Trainee Paediatric Surgeons regarding the use of and attitudes towards laparoscopic inguinal hernia repair.
Rohini Sahay, GV Murthi
Sheffield Children's Hospital, Sheffield, United Kingdom

Abstract

Aims : We report the findings of a national survey of UK Paediatric Surgery Consultants and Trainees about the current situation in clinical practice regarding: attitudes, concerns, audit, training issues in relation to the use of laparoscopic repair of inguinal hernia.

Methods: A Surveymonkey questionnaire was circulated to the BAPS mailing list after approval by BAPS Scientific Committee; Trainees were contacted via the TRIPS forum.

Results: There were 82 respondents (73 complete). Findings are summarised in Table 1.

Conclusions: About 7000 operations for inguinal hernia are performed in children annually according to NHS Hospital Episode Statistics(HES); 50% are in infants-80% in males. Patient Choices and Getting It Right First Time (GIRFT) recommend that patients be offered all available treatment options to choose from. With 50% of centres/consultants not offering the laparoscopic option, parents/patients are denied this opportunity. On the other hand, concerns regarding the safety and efficacy of the laparoscopic approach, lack of training/infrastructure need to be addressed, perhaps through a national study.

Table 1: Main results of the survey; ‘%’ – indicates proportion of respondents

CONSULTANT RESPONDENTS

82 (73 completed survey)

>10 years experience

50%

>25 hernia repairs/ year

84%

Experienced laparoscopist

78%

Centre offers laparoscopic option?

52%

Audit undertaken?

63%; 24% showed laparoscopic outcome poorer

Which is better?

50% felt open repair is better

Need to see more evidence of benefit for laparoscopy

60%

Main concerns regarding laparoscopy?

  • Recurrence higher – 60%
  • Higher operating time – 64%
  • Higher cost – 36%
  • Vas/vessel injury – 25%

Lack of training/infrastructure to offer laparoscopy

25%

What would increase uptake of the laparoscopic approach?

  • More evidence of benefit (53%)
  • Learning opportuity (11%)
  • Unwilling to change (42%)

TRAINEES (45 RESPONDENTS)

  • Would like to be trained (80%)
  • Consultant support (97%)
  • Unsure of relative benefits (62%)
  • Untrained in laparoscopic method (27%)

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