BMJ  2008;336:1033 (10 May), doi:10.1136/bmj.39568.437975.80

Letters

Hernia repair

Outcomes other than recurrence should be analysed

The first 150 words of the full text of this article appear below.

Nordin and van der Linden’s attempt to link outcome after groin hernia surgery with surgeon volume, using the Swedish hernia register, is commendable.¹ But even they must admit that using recurrence as the only outcome is crude, outdated, and of little relevance nowadays. In addition, not all hernia operations are equivalent—size and difficulty vary greatly—and their study took no account of this.

Twenty years ago, the success of hernia repair was measured mainly by recurrence. Since the advent and widespread use of mesh patches, recurrence rates have fallen greatly,² and other outcomes are now of greater clinical importance.³ A "good result" is not simply a hernia that does not recur.

Long term postoperative pain and discomfort are currently the major problems after groin hernia repair, with an incidence of 10-25% one year after operation. They may be related to intraoperative nerve damage and hence associated with surgical technique and surgeon’s . . . [Full text of this article]

¹ British Hernia Centre, London NW4 4RS

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