Fear over hernia surgery

HERNIA operations carried out by trainee surgeons show a far higher rate of complications and recurrence than was previously thought, according to a study to be published soon.

The findings, which focus on one health district where hernia repair is routinely carried out by junior staff, confirms the worst fears of the Royal College of Surgeons. The college last week warned of a high failure rate and post-operative problems in British hospitals following one of the most common NHS surgical procedures. About 150,000 people develop a hernia - a bulge caused by weakness in the muscle lining the abdomen - each year.

Many consultant surgeons view surgery to repair hernias as mundane and routine, while trainee surgeons regard any hernia as 'theirs by right', according to one specialist. 'It is regarded as an operation that juniors practise on, but everyone has a learning curve,' he said. 'A good hernia repair is as difficult as some complex cancer surgery.'

The recurrence rate is about 5 per cent even when the operation is carried out by the most experienced surgeon.

Andrew Kingsnorth, a consultant surgeon and chairman of the RCS working party which has compiled new guidelines on groin hernias, said that many senior surgeons would be 'alarmed' by the new data. 'There has been a tendency to delegate it (hernia repair) as simple surgery and this is simply not the case,' he said.

Surgeons are reluctant to specialise in hernia treatment, he added, and lack of interest is also partly responsible for a reliance on old-fashioned repair methods.

The new study will also increase pressure on the Department of Health for large-scale clinical trials to compare methods of hernia repair, and prevent some surgeons endorsing newer techniques which have not been adequately tested.

More than a quarter of surgeons use an outdated 'darn' technique instead of a more sophisticated repair which has a far lower recurrence rate.

At the other end of the spectrum, some private clinics rely on a 'hard sell' to promote new treatments without sufficient long-term data to support them, Mr Kingsnorth says. About 10,000 operations are performed privately each year.

The college is also warning of the 'unacceptable' death rate among older patients who develop serious complications while waiting for surgery and have to be treated as emergency cases. An increase in day-surgery treatment would ease waiting lists and save cash, but again there is resistance to change.

Only 7 per cent of hernias are done as day surgery in Britain compared with 80 per cent in America. Some 80,000 operations are carried out on the NHS each year; patients are usually hospitalised for between three and five days at a cost to the NHS of between pounds 250- pounds 300 per day. Among non-emergency cases, recurrence of the condition is the greatest concern; up to 20 per cent of operations have to be repeated within five years.