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An international survey of 1014 hernia surgeons: outcome of GLACIER (global practice of inguinal hernia repair) study

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Abstract

Introduction

The practice of inguinal hernia repair varies internationally. The global practice of inguinal hernia repair study (GLACIER) aimed to capture these variations in open, laparoscopic, and robotic inguinal hernia repair.

Methods

A questionnaire-based survey was created on a web-based platform, and the link was shared on various social media platforms, personal e-mail network of authors, and e-mails to members of the endorsed organisations, which include British Hernia Society (BHS), The Upper Gastrointestinal Surgical Society (TUGSS), and Abdominal Core Health Quality Collaborative (ACHQC).

Results

A total of 1014 surgeons from 81 countries completed the survey. Open and laparoscopic approaches were preferred by 43% and 47% of participants, respectively. Transabdominal pre-peritoneal repair (TAPP) was the favoured minimally invasive approach. Bilateral and recurrent hernia following previous open repair were the most common indications for a minimally invasive procedure. Ninety-eight percent of the surgeons preferred repair with a mesh, and synthetic monofilament lightweight mesh with large pores was the most common choice. Lichtenstein repair was the most favoured open mesh repair technique (90%), while Shouldice repair was the favoured non-mesh repair technique. The risk of chronic groin pain was quoted as 5% after open repair and 1% after minimally invasive repair. Only 10% of surgeons preferred to perform an open repair using local anaesthesia.

Conclusion

This survey identified similarities and variations in practice internationally and some discrepancies in inguinal hernia repair compared to best practice guidelines, such as low rates of repair using local anaesthesia and the use of lightweight mesh for minimally invasive repair. It also identifies several key areas for future research, such as incidence, risk factors, and management of chronic groin pain after hernia surgery and the clinical and cost-effectiveness of robotic hernia surgery.

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Data availability

The original survey used for data collection has been provided under supplementary material. All clinically relevant data has been summarized in the article, and if further details are needed, the authors agreed to provide them on request.

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Author information

Authors and Affiliations

  1. Royal Derby Hospital, University Hospital Derby and Burton NHS Trust, Derby, UK

    K. D. L Nanayakkara, N. G. Viswanath & B. Madhok

  2. Forth Valley NHS Trust, Larbert, UK

    M. Wilson

  3. South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK

    K. Mahawar

  4. Belle Vue Hospital, Kolkata, India

    S. Baig

  5. Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark

    J. Rosenberg

  6. Cleveland Clinic, Cleveland, USA

    M. Rosen & A. Prabhu

  7. Manchester University NHS Foundation Trust, Manchester, UK

    A. J. Sheen

  8. Mount Sinai Hospital, New York, USA

    E. Goodman

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  1. K. D. L Nanayakkara
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Correspondence to K. D. L Nanayakkara.

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Nanayakkara, K., Viswanath, N.G., Wilson, M. et al. An international survey of 1014 hernia surgeons: outcome of GLACIER (global practice of inguinal hernia repair) study. Hernia 27, 1235–1243 (2023). https://doi.org/10.1007/s10029-023-02818-8

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