HERNIA FACTFILE
There are 80,000 operations for repair of groin hernias in the UK annually
(and 40,000 NHS prescriptions for trusses). This works out at 2-3 operations
per general practitioner (with 2,000 patients) and 10-15 per 10,000 of the
population per year. In the USA the rate per 10,000 of the population is 30-45,
while in Australia and Norway it is 20-30.
The incidence of hernias increases with age, and is higher in men. Inguinal
hernias make up 90% of all hernias, while femoral hernias comprise the
remaining 10%.
Complications of hernias
Strangulation can lead to intestinal obstruction, perforation, infection and
death.
Annual incidence of strangulation is 0.5 per 10,000 patients (or 1 every 10
years per general practitioner). Mortality from strangulated hernia is 7-14%
(most deaths occur in those aged over 75 years).
Femoral hernias are more likely to strangulate than inguinal hernias:
although femoral hernias comprise only 10% of all hernias, they are responsible
for between one-half and one-third of all strangulations. Femoral hernias are
also twice as likely to require bowel resection as inguinal hernias.
Direct inguinal hernias have low rates of strangulation.
Recurrence of hernias
The rates of hernia recurrence after surgical repair range from less than 1%
(for the Shouldice operation) through 10% (for primary repairs) to 20% (for
secondary repairs). Recurrence rates depend on the technical skill of the
surgeon and on the method used.
Patterns of care
General practitioners refer over one-half (58%) of their patients who
present with a hernia directly to a surgeon -- 44% to the NHS and 14% for
private operations. Currently, the average waiting time for repair on the NHS
is 2 months. Only 7% of hernia repairs are carried out as day cases: this
figure should be over 30%. Stay in hospital averages 5 days, which could be
reduced.
Unnecessary time off work is taken to recuperate from hernia repair.
Surgeons recommend 4 weeks off work, while general practitioners recommend 6
weeks. However, 2-3 weeks is probably appropriate.
Sources
Kingsnorth AS. Tightening up on groin hernia repair (Editorial). Hospital
Update 1993; 19: 579-80.
Royal College of Surgeons of England. Clinical guidelines on management of
groin hernia in adults. London: RCS, 1993.
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