Effect of a Pediatric Surgeon on Pediatric Inguinal Hernia Repair-Evaluation of the Importance of Surgeons with Subspecialty Training by a Single-Hospital Comparative Experience

Abstract

Background: Inguinal hernia repair is one of the most common operations performed by pediatric surgeons. The aim of this communication is to analyze the differences in results of pediatric inguinal hernia repairs in a single hospital with and without the participation of a pediatric surgeon. Methods: All data were collected from the children who underwent hernia repairs at Cheng Ching hospital between December 2002 and November 2004. At present Cheng Ching Hospital is a regional hospital that offers all types of surgical specialists, but before December 2003 there was a lack of pediatric surgeons. The cases mentioned above were divided into group Ⅰ (December 2002 to November 2003) and group Ⅱ (December 2003 to November 2004). Group Ⅱ was further divided into group Ⅱa (operations performed by a general surgeon or urologist) and group Ⅱb (performed by a pediatric surgeon). Cases done by general surgeons or urologists were compared with those done by a pediatric surgeon. The Student's t test was used for continuous variables. Results: In group Ⅰ the operations for 102 cases were performed equally by general surgeons and urologists. In group Ⅱ a pediatric surgeon performed 64.2% of operations for 190 cases. Although the number of cases in group Ⅱ was greater than in group Ⅰ, the number of operations performed by general surgeons was significantly lower (P＜0.001) while the number of operations performed by urologists was similar to that in group Ⅰ. Patients in group Ⅱb were younger than in group Ⅱa (P＜0.001) but not younger than in group Ⅰ (P=0.08). Patients in group Ⅱa were also older than in group Ⅰ, but the difference was not significant (P=0.07). Group Ⅱb had more young cases (＜1-year-old, P＜0.001) and bilateral operations (P＜0.001) than in groups Ⅰ and Ⅱa. There were no surgical complications and recurrence was not found during this study. Conclusions: Regional hospitals that offer the service of pediatric surgeons receive an increasing number of patients requiring inguinal hernia repairs. This increase is particularly prevalent in younger patients and in cases with bilateral hernias require treatment. These results therefore reveal that subspecialty training is important because it affects the intention of patients and their parents to seek medical advice.