Management of primary and recurrent XXXX by surgeons from the South West of England.

@entity169 @entity547
BACKGROUND: The National Institute of Clinical Excellence (NICE) has advocated open mesh repair for primary @entity547 but suggested laparoscopic repair may be considered for recurrent @entity547 . AIM: To establish current surgical practice by surgeons from the South West of England. METHODS: A postal survey was distributed to 121 consultant surgeons and a response rate of 75% was achieved. RESULTS: The majority (86%) of the surgeons surveyed performed @entity547 repairs, and most (95%) of these used open mesh repair as standard for primary @entity169 . Only 8% used laparoscopic repair routinely for primary @entity547 . Few consultants (only 28%) were able to quote formally audited @entity547 rates. A total of 90% of respondents still employed open mesh repair routinely for recurrent @entity547 ; however, if mesh had been used for the primary repair, this figure fell to 55%. Some 7% of respondents recommended laparoscopic repair for recurrent @entity547 , but this increased to 17% if the primary repair was done with mesh. All laparoscopic surgeons in the South West employed the totally extraperitoneal approach (TEP). There was a range of opinion on the technical demands of repair of a recurrent @entity547 previously mended with mesh; the commonest cause of mesh failure was thought to be a medial direct recurrence (insufficient mesh medially). CONCLUSIONS: Current surgical practice for primary @entity547 in the South West England reflects NICE guidelines although many surgeons continue to manage recurrent @entity547 by further open repair. In this survey, there was anecdotal evidence to suggest that @entity547 can be managed effectively by open repair.
