Factors influencing choice of inguinal hernia repair technique among surgeons and surgical trainees: a descriptive crosssectional Study in Kenyatta National Hospital, Nairobi-Kenya
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Date
2015Author
Osilli, Sikodah D J
Type
ThesisLanguage
enMetadata
Show full item recordAbstract
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).
Publisher
University of Nairobi