Changing the path of inguinal hernia surgery decreased the recurrence rate ten-fold. Report from a county hospital.

Objective: To audit the effect of changes in treatment of inguinal hernias on recurrence rate.

Design: Retrospective analysis of consecutive patients operated on in 1990 and prospective analysis of consecutive patients operated on in 1996. Follow up with questionnaire followed by selective clinical examination.

Setting: County hospital, Sweden.

Subjects: 144 patients with 147 inguinal hernias operated on in 1990 and 154 patients with 165 inguinal hernias operated 1996. on in

Interventions: In 1993, we changed many aspects of the treatment of inguinal hernia. We introduced new techniques such as Shouldice, Lichtenstein, and laparoscopic hernia repair. Non-absorbable polypropylene sutures replaced the braided absorbable sutures previously used. Inguinal herniorrhaphy went from a "low status" operation to a high status operation and became a primary teaching operation for surgical residents.

Main outcome measures: Recurrence rate at 5 year follow up.

Results: The 5 year recurrence rate decreased from 28% in 1990 to 3% in 1996 (p < 0.001). The m edian operating time increased from 35 minutes in 1990 to 78 minutes in 1996 (p < 0.001).

Conclusion: Changing the strategy of inguinal hernia surgery by introducing uniform operating techniques and new materials dramatically improved the results and allowed us to achieve recurrence rates comparable to those seen in specialised hernia centres.