Quality control after hernia operation

Abstract

An important feature in surgery is the absence of wound infection after elective sterile operation. That's why the VQG (Verein zur Qualitätssicherung im Gesundheitswesen) from Berne recommends as a standard control the surveillance of wound healing, where hernia repair is suited for a tracer operation [1]. In our hospital retrospectively all 106 patients of the year 1999 were asked by a questionnaire, 3 month after operation, if their wound healed primarily or if they noticed any signs of infection or even had to be re-operated again. Most hernias were indirect (71) or direct (11), followed by umbilical hernias (11), epigastric or incisional hernias (4), femoral hernias (2). The majority of procedures were a Shouldice repair (43), followed by mesh implantation according to Lichtenstein (33) or Bassini repair (15). 14 times an umbilical or epigastric hernia was operated by Mayo's method. One Stoppa operation was performed. 7 Hernias were incarcerated at the time of operation. 51 hernias were on the right, 41 on the left side, 5 on both sides. Mean age of patients was 52.9 years; mean duration of hospital stay was 4.42 days. After Shouldice repair hospital stay was 3.9 days with an average patients age of 48.3 years, after Bassini 5.41 days (mean age 46.4 years), after Lichtenstein repair 5.23 days (mean age 66.0 years). 82 (77.4%) from 106 patients returned the questionnaire. 67 (81.7%) were completely satisfied, 11 (13.6%) mentioned minor problems. So 95.1% had a normal primary wound healing without infection. There was no correlation between wound healing, type of hernia, age, hospital stay, surgeon or method of operation. In the same study other complications occurred (e.g. 5% recurrences of hernias, nerve lesions), that could not be integrated into the evaluation because they were excluded by definition. Studying the tracer "wound healing after groin hernia repair" allows an approximate follow-up for quality control with little expense. Because of the narrow point of view and the neglect of other complications in the same investigation we estimate the power of the result as limited.