Open inguinal hernia repair: Better consent for a safer practice, a retrospective study

Noureldin, Khaled; Issa, Mohamed; Shehata, Ramez; Elsherbiney, Mohammed; Attar, Ahmed; Ibrahim, Emad

doi:10.4103/ejs.ejs_68_22

Open inguinal hernia repair: Better consent for a safer practice, a retrospective study

Authors

Abstract

Introduction
Mesh repair is the gold standard for elective inguinal hernias. The recurrence rate is 1–3%. Chronic pain is documented in 10–15%. Consent is an essential form to proceed with any. Our study aimed to evaluate the practice in consenting patients with inguinal hernia, according to British Hernia Society (BHS) Standards, for safer practice and better outcomes.
Patients and methods
The authors underwent a retrospective study on 242 patients. These patients were subjected to open inguinal hernia repair, and they were followed up for over 1.6 years. Patients under 18, with a history of previous repair and laparoscopic repair, were excluded from the project.
Results
The patients were divided into two groups. Group A, patients signed E-consent, which was preprepared, including all required operative details. And group B, in which written consent was used and signed on an operative day. Despite using mesh in all patients, in group B, the mesh was missed in 11.7% of the consent forms and half of the clinic letters. Postoperative readmissions were 6.4, 8.5, and 1.1% at weeks, months, and 18 months, respectively. The main reasons for readmission were pain (2%), seroma (0.4%), hematoma (0.4%), wound infection (0.8%), and recurrence (0.8%). After the follow-up, the overall complication rate was 4.4%. Although hernia recurrence and chronic pain are crucial to state formally as a postoperative complication, they were not mentioned in group B, in 10% and 15% of the cases. In contrast, nonspecific complications were documented in greater than 90%. Damage to cord structures and postoperative management plans were found in 60 and 30%.
Conclusion
All surgeons of different grades were not adequately adherent to BHS, exposing the firm to negligence and complaints. Prepared forms and leaflets are advised to improve the quality of service regarding the General Medical Council domains.

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