Factors influencing choice of inguinal hernia repair technique among surgeons and surgical trainees: a descriptive crosssectional Study in Kenyatta National Hospital, Nairobi-Kenya

Abstract

Background: Inguinal hernia repair surgery is one of the most frequently performed surgical procedures worldwide. Tension-free mesh repair has become a standard procedure in the developed world due to the proven lower complication rates associated with this technique. Clearly-defined structures for inguinal hernia repair training are present in the West. However, in our setting, it is not known what factors influence surgeons and surgical trainees’ choice with respect to operative technique, and whether this choice is influenced by the evidence-base. This study sought to highlight factors that may influence decisions concerning inguinal hernia repair techniques at Kenyatta National Hospital (KNH). Objective: To establish the factors that influence the choice of inguinal hernia repair technique among surgeons and surgical trainees at KNH. Study design: This was a descriptive cross-sectional study Study duration: One (1) month Setting: Kenyatta National Hospital General Surgical Unit Study Population: Surgeons and surgical trainees Methodology: Data was collected through printed pre-tested questionnaires. Data collected included: qualification of the operating doctor, level at which practical training on inguinal hernia repair occurred, awareness of the surgeons and surgical trainees of the various inguinal hernia repair methods, inguinal hernia repair method(s) used for the past three (most recent) inguinal hernia operations and reasons for using that /those repair method(s). Data from all the doctors was entered into an MS access database, and exported to EpiData and Stata software for analysis. Frequency tables and graphs have been used to present the analyzed data. Approval to carry out the study was sought from the KNH and University of Nairobi Ethics and Research Committee Results: Fifteen (15) consultant surgeons and sixty (60) surgical trainees were recruited. The modified Bassini is the repair method majority have been trained in (98.67% of the respondents); followed by the Lichtenstein method. Training by an experienced peer (both outside and during residency) is the most common way these two methods were learned by the respondents. The most frequently used hernia repair method is the Lichtenstein method (38.22%). The laparoscopic hernia repair methods (TAPP, TEP) – as opposed to the suture and mesh repairs - are the least used (less than 3%). Some of the most frequently cited reasons influencing choice of repair technique include: training on the technique, ease of the technique, availability of repair material and equipment and decreased recurrent rate. Conclusion: Training on the technique plays a big role in the choice of technique to use. Residency is a critical time period for training in hernia surgery. Most trainees are trained by their fellow peers. Limited resources act as a hindrance to the use of tension free hernia repair methods (both open and especially laparoscopic).