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Hernias are characterized by protrusion of an organ or tissue through its surrounding cavity and often require surgical repair. In this study we identify 65,492 cases for five hernia types in the UK Biobank and perform genome-wide association study scans for these five types and two combined groups. Our results show associated variants in all scans. Inguinal hernia has the most associations and we conduct a follow-up study with 23,803 additional cases from four study groups giving 84 independently associated variants. Identified variants from all scans are collapsed into 81 independent loci. Further testing shows that 26 loci are associated with more than one hernia type, suggesting substantial overlap between the underlying genetic mechanisms. Pathway analyses identify several genes with a strong link to collagen and/or elastin (ADAMTS6, ADAMTS16, ADAMTSL3, LOX, ELN) in the vicinity of associated loci for inguinal hernia, which substantiates an essential role of connective tissue morphology. Hernias involve protrusion of an organ or tissue through its surrounding cavity. Here the authors carry out GWAS for five types of hernia and find 81 variants, most of which are associated with inguinal hernia; downstream analysis suggests an important role for connective tissue morphology. [ABSTRACT FROM AUTHOR]

Background: Involving patients and communities with health research in low- and middle-income countries (LMICs) contributes to increasing the likelihood that research is relevant in local context and caters to the needs of the population, including vulnerable and marginalised groups. When done right, it can also support empowerment of wider communities in taking ownership of their own health, lead to increased access and uptake of health services and generally improve the wellbeing of individuals. However, the evidence base of how to undertake successful community engagement and involvement (CEI) activities in LMICs is sparse. This paper aims to add to the available literature and describes how the Global Health Research Unit on Global Surgery's (GSU) team in Ghana worked collaboratively with the Unit's team in the UK and a UK-based Public Advisory Group to involve community stakeholders in rural Ghana with surgical research. The aim was to explore ways of reaching out to patients and community leaders in rural Ghana to have conversations that inform the relevance, acceptability, and feasibility of a clinical trial, called TIGER. Methods: As this kind of larger scale involvement of community stakeholders with research was a novel way of working for the team in Ghana, a reflective approach was taken to outline step-by-step how the GSU team planned and undertook these involvement activities with 31 hernia patients, two Chiefs (community leaders), a community finance officer and a local politician in various locations in Ghana. The barriers that were experienced and the benefits of involving community stakeholders are highlighted with the aim to add to the evidence base of CEI in LMICs. Results: GSU members from the UK and Ghana planned and organised successful involvement activities that focused on establishing the best way to talk to patients and other community stakeholders about their experiences of living with hernias and undergoing hernia repairs, and their perceptions of the impact of hernias on the wider community. The Ghanaian team suggested 1:1 conversations in easily accessible locations for rural patient contributors, creating a welcoming environment and addressing contributors in their local dialects. A UK-based Public Advisory Group helped in the initial stages of planning these conversations by highlighting potential barriers when approaching rural communities and advising on how to phrase questions around personal experiences. Conversations mainly focused on understanding the needs of hernia patients in rural Ghana to then incorporate these in the design of the TIGER trial to ensure its relevance, acceptability and feasibility. When talking to patient contributors, the GSU teams found that they were more likely to open up when they knew members of the team and the opportunity to speak to local leaders only arose because of the Ghanaian team members being well-respected amongst communities. The experiences of the patient and community contributors led to changes in the study protocol, such as including women in the patient cohort for the trial, and allowed the GSU teams to confirm the relevance and acceptability of this trial. These conversations also taught the team a lot about perceptions of health in rural communities, allowed the Ghanaian team to establish relationships with community leaders that can be utilised when future studies need input from the public, and has changed the minds of the Ghanaian research team about the importance of involving patients with research. Conclusion: This paper contributes to the evidence base on successful CEI activities in LMICs by providing an example of how CEI can be planned and organised, and the benefits this provides. The conversations the teams had with patient contributors in Ghana are an example of successful patient consultations. Even though there are certain limitations to the extent of these involvement activities, a solid foundation has been built for researchers and community stakeholders to establish relationships for ongoing involvement. Plain English summary: Evidence in the literature shows that research that was designed and implemented with the help of patients or other members of the community affected by the study, is more likely to be relevant to the needs of the end user. This can have positive effects on the quality and impact of the study. However, working collaboratively with patient or public contributors can have certain challenges, especially in low- and middle- income countries. For example, factors such as different languages or dialects, religious beliefs, health beliefs, level of literacy, understanding of research, and poverty can potentially make it more difficult for researchers to reach, communicate and involve relevant members of the public. On top of this, the evidence base for successfully implementing these so-called community engagement and involvement activities is sparse, making it more challenging for researchers to learn from others' experiences. Members of the Global Surgery Unit, who are based in Ghana, proposed a clinical trial to address the shortfall of specialist surgeons at rural hospitals. This will be achieved by training medically qualified doctors, who have not yet gone through the specialist training to become qualified surgeons, to perform inguinal hernia repairs proficiently. Before the study gets funded and a protocol can be designed, the researchers need to ensure its relevance, acceptability, and feasibility. This is usually done by getting the opinion and thoughts of key stakeholders, mainly individuals who will be affected by the research. To achieve this, the team in Ghana worked together with Global Surgery Unit members in the UK to identify the best ways to approach and have conversations with 31 inguinal hernia patients who either previously had surgery or currently live with hernias, two Chiefs (community leaders), a community finance officer and a local politician in a variety of locations in Ghana that are representative of the patient cohort for the study. The intention was to understand the impact of hernias on individual patients, their families, and entire communities to inform the relevance, acceptability and feasibility of the clinical trial, and ensure that relevant aspects are captured in the study protocol. A UK-based public advisory group provided initial input to help eliminate potential barriers of addressing patient contributors in rural Ghana. This paper states in detail how these conversations were planned and organised, the challenges the team had to overcome, and what they learned and gained from talking to community members - which goes far beyond just informing a study. [ABSTRACT FROM AUTHOR]

Purpose: Groin hernia repair is the most frequently performed general surgical operation in the UK. Complications from laparoscopic and open repair are well recognised; however, potential differences are yet to be considered in relation to litigation. Methods: Administrative data were obtained and analysed from the NHS Litigation Authority for inguinal hernia-related claims from 1995 to 2016. Claims identified as using an open or laparoscopic approach were compared. Results: 880 claims were made, 760 had been settled. 88 laparoscopic and 241 open procedures were identified; 65% laparoscopic and 63% open hernia claims were found to be in favour of the claimant. Payouts totalled to 4.1GBP/4.8EUR/5.3USD million and 9.4GBP/11.0EUR/12.1USD million for laparoscopic (mean 82,824GBP/96,579EUR/106,453USD) and open (mean 66,796GBP/77,892EUR/85,852USD) approaches, respectively. The most common reasons for claim initiation were visceral/vascular injury (54%) in the laparoscopic group, and testicular complications or chronic pain (35%) in the open group. Additional procedures were necessary for 48% and 44% of laparoscopic and open claims, respectively. The highest average payouts were associated with visceral injury, (laparoscopic 116,482GBP/135,820EUR/149,715USD; open 199,103GBP/232,246EUR/255,905USD) and vascular injury (laparoscopic 88,624GBP/103,369EUR/113,892USD; open 64,460GBP/75,163EUR/82,870USD). Additional procedures resulted in an average payout of 93,352GBP/108,917EUR/120,008USD (laparoscopic) and 60,408GBP/70,506EUR/77,657USD (open). The most common additional procedures were corrective visceral/vascular repairs, orchidectomy and recurrent hernia repair. Conclusions: The rate of litigation for clinical negligence in inguinal hernia surgery in the UK is increasing. Whilst there has been a recent increase in laparoscopic hernia repair claims, the volume and burden of claims related to open procedures remain greater. [ABSTRACT FROM AUTHOR]

Introduction: In this invited commentary, we aim to quantify and explain the variation between, and also within, developed healthcare systems (using the UK as an example) and low- to middle-income countries (LMICs). Rather than including complex cases, we have looked only at 'uncomplicated' primary unilateral inguinal hernias, an area where limited variation may be identified.Methods: Data were obtained from Hospital Episode Statistics and structured surveys in the United Kingdom and in low- and middle-income countries.Conclusion: There is widespread variation in the repair of 'uncomplicated' primary inguinal hernias worldwide and within developed healthcare systems. [ABSTRACT FROM AUTHOR]

Purpose: Elective inguinal hernia repair (IHR) is one of the most commonly performed operations in the UK. As with all procedures, informed consent is essential. Pre-made consent forms have been suggested to improve consenting practice. This study aimed to assess the usage and quality of pre-made hernia-specific consent forms (PCF) in the UK.Methods: A freedom of information request was sent to all UK NHS Trusts asking: (1) does the trust perform IHRs; (2) do they have a PCF; and (3) to send a copy. Complications lists on received forms were reviewed and compared to those listed on the British Hernia Society (BHS) "patient information" webpage.Results: 157/185 Trusts (85%) responded. 117/157 (75%) perform IHRs; 16/117 (14%) use PCFs. The number of reported risks was variable (range 4-18), as was the content of each form (28 different risks were listed). Quoted percentage risks were inconsistent (e.g. recurrence range < 1-5%). The frequency of each BHS-quoted risk was (open/laparoscopic): Bleeding 62/75%; infection 85/92%; seroma 31/42%; damage to testicular blood supply 69/75%; damage to abdominal contents NA/25%; haematoma 62/67%; venous thromboembolism 54/50%; recurrence 85/83%; chronic pain 77/58%; mesh infection 23/8%. Zero forms contained all BHS-quoted risks.Conclusions: Whilst the consent form only provides documentation of the consent process, this study suggests that PCFs do not improve the quality of consent as both the type and likelihood of quoted complications were highly variable between Trusts. As follow-up for elective procedures is rare, it is unlikely that this variability reflects actual measured outcomes. [ABSTRACT FROM AUTHOR]

Background: Inguinal hernia repairs are one of the most commonly performed procedures in the UK. This study examined the adequacy of the consent process for inguinal hernia repair focusing on the patients' understanding of the relative risks and benefits of laparoscopic versus open repair. Methods: The study consisted of a retrospective postal questionnaire poll of 200 patients (162 males and 38 females) aged between 42 and 85 who had been assessed in the surgical outpatients (within the last 12 months) and received counselling regarding their inguinal hernia repair. Patient perception regarding the risks and merit of laparoscopic versus open repair was surveyed using a multiple-choice questionnaire. Results: One hundred and twenty patients (60 %) returned their questionnaires, after excluding recurrent and bilateral hernias; 97 patients were entered into the study. The majority of patients reported a perception that a laparoscopic repair was safer and quicker than open (61.5 and 75.4 %, respectively); 29.2 % of patients felt that the recurrence rate was lower with a laparoscopic repair with 50.8 % of patients expressing that open repair had a higher complication rate than laparoscopic treatment; 81.5 % of patients correctly appreciated that laparoscopic repair had a quicker return to work; and 76.9 % of patients felt that laparoscopic repair was the only method, which could be undertaken as a day case procedure. Conclusion: The results show that many patients have an incorrect perception of laparoscopic inguinal hernia repair, which may reflect an inadequate consent and counselling process. No definitive evidence exists regarding the superior safety and efficacy of one method over another, but it would appear that a significant number of patients are unaware of this. [ABSTRACT FROM AUTHOR]

Introduction Clinical differences between open and laparoscopic inguinal hernia repair and between Local and General anaesthetic are minimal in the majority of cases. This study aims to provide direct cost comparison data between the different approaches to facilitate a better understanding of the relative costs of providing inguinal hernia repair via different surgical approaches. This will facilitate a better understanding of the cost implications of running a comprehensive hernia service. Methods Six UK reference centres provided mean index costs for Laparoscopic Trans abdominal preperitoneal repair (TAPP), Laparoscopic Transabdominal Extraperitoneal (TEP), open repair with General Anaesthetic (GA) and open repair with Local Anaesthetic (LA). Daycase versus overnight stay were also considered. Relative costs of the different approaches were calculated and a sensitivity analysis undertaken. Results The least expensive option was open repair under LA as a day case. Requirement of a GA increased the cost by approximately 75%. Laparoscopic TEP repair was the most expensive option costing 2.5 times as much as open repair under LA. The average cost of an overnight bed was €332 (€181-€543), however there was considerable variation, as there was for Mesh and endoscopic equipment which ranged from 25-100% of list price depending on local procurement contracts. Discussion Data from UK and Swedish registries suggest that there is capacity for increasing the proportion of inguinal hernias repaired under local anaesthetic. If remuneration is fixed (as it is in the UK), then service provision should be planned across the whole service to maximise LA daycase throughput, thus generating surplus income which may be directed to covering the cost of more expensive procedures where clinically indicated. This article has been adapted for an international audience from one previously published in the UK. [ABSTRACT FROM AUTHOR]

Abstract: Inguinal hernias are common, affecting one in four men in their lifetime. They are much less common in women with a lifetime risk of about 3%. Consequently, inguinal hernia repair is one of the commonest operations with more than 20 million operations performed annually worldwide. Africans have a much higher incidence of hernias than Caucasians and this is thought to be because of the anatomical configuration of the African pelvis. Many hernias in poorer countries are not repaired, so that presentation as an emergency and indeed mortality due to complications are much more often seen than in more affluent societies. Surgeons must be familiar with the anatomy of the groin from both the anterior and pro-peritoneal aspects. The anatomy of the inguinal region as seen from the posterior aspect has gained increasing importance, primarily because of the advent of laparoscopic repair but also because of the potential for pro-peritoneal repair using open techniques. Laparoscopic repair is recommended by the National Institute for Health and Clinical Excellence as one of the treatment options for inguinal hernia repair. Patients should be fully informed of all the risks and benefits associated with each of the three procedures offered (totally extraperitoneal, transabdominal preperitoneal or open). Recurrence rates vary widely. In large series, recurrence rates well below 1% are described. However, in real-world practice, such rates are not achieved. A more realistic figure for 10-year recurrence of a hernia repair by a general surgeon is probably 3–5%. Chronic groin pain is much commoner after inguinal hernia repair than most surgeons acknowledge, probably being evident in one-third of cases. [Copyright &y& Elsevier]

Inguinal hernia is the commonest surgical operation. This is a large study from a district general hospital. The study spanned over 2 years with 2 further years of follow up. It is a retrospective analysis of eight hundred and seventy seven (877)inguinal hernia operations performed in a district general hospital. The following factors were looked at: type of repair, grade of surgeon performing the procedure and outcome of various repairs. The results showed that the most common technique was the Lichenstein's repair(58%). Recurrence rates were between 0.4%-30% depending on types of hernia repair. [ABSTRACT FROM AUTHOR]

Purpose: Since 1995, litigation following surgical procedures has cost the National Health Service (NHS) over 1.3 billion GBP (Great British Pounds)/2.1 billion USD (United States Dollars)/1.4 billion Euros. Despite it being the most commonly undertaken general surgical operation, no study has examined clinical negligence claims in England following groin hernia repairs. Methods: Data from the NHS Litigation Authority of all claims made from 1995 to 2009 was obtained and interrogated. Results: In total, 398 claims were made. Of these, 209 cases had been settled, of which 144 (46.6%) were in favour of the claimant to a cost of 7.35 million GBP/12 million USD/7.93 million Euros. Testicular injury and chronic pain featured in 40% of all claims. Visceral injuries and injuries requiring corrective procedures were the only predictors of a successful claim ( P = 0.015 and P = 0.002, respectively). Claims associated with visceral and vascular injuries were more likely to occur in laparoscopic than in open repairs. Sexual dysfunction and chronic pain resulted in the highest average payouts of 85,467 GBP/140,565 USD/92,177 Euros and 81,288 GBP/133,693 USD/87,674 Euros, respectively. Conclusion: Patients should be fully informed of the incidence of testicular injury and chronic pain during the consent process. Approaches minimising visceral and vascular injury particularly in laparoscopic repair should be adopted to reduce litigation and improve patient care. [ABSTRACT FROM AUTHOR]

Background: Even though laparoscopic hernia repair has been shown to be an efficient method with the benefits of minimally invasive surgery, it is poorly accepted in general surgical practice. Aims: To evaluate the safety, complications and recurrence rates of laparoscopic totally extraperitoneal (TEP) repair and reflect on the learning curve. Setting: Single surgeon series from Princess Royal Hospital, Telford, United Kingdom. Materials and Methods: Prospectively collected data of laparoscopic TEP repairs performed by a single surgeon (JDP) between January 2001 and February 2006 were analyzed. 134 patients in the age range of 19 to 86 years had laparoscopic TEP repair for 209 inguinal herniae. Herniae were classified according to the type and Nyhus grades. A 10 mm reusable and two 5 mm ports were placed in the midline subumbilically. A large 12 x 15 cm polypropylene mesh was used with a lateral fish tail slit around the cord structures. No mesh fixation was employed and the rectus sheath at the umbilical port was closed in only 27% of the patients. Operating times, intraoperative and postoperative complications were recorded. The majority of the patients stayed overnight in the hospital. Overall morbidity was 13% with no wound or mesh infections. Overall recurrence rate was 2.4% and recurrence rate for primary hernia repair was 1.85%. Follow-up period was 6 months to 66 months with a median of 24.5 months. Conclusions: Laparoscopic TEP repair is a safe and efficient method of hernia repair with low morbidity but with a long learning curve. [ABSTRACT FROM AUTHOR]

Introduction: After the introduction of laparoscopic hernia repair to the National Health Service (NHS), we studied the benefits and practicality of carrying out this specialised hernia repair technique in a District General NHS hospital. Methods: Patients with groin hernia were stratified into groups for day-surgery or inpatient care based on Trust guidelines. Patients underwent laparoscopic trans-abdominal pre-peritoneal (TAPP) inguinal hernia repair by a single consultant surgeon. Patients were followed-up in the clinic. All data were collected prospectively on a structured proforma. Postal questionnaire was sent to 100 randomly selected patients who had surgery more than two years ago and responses were evaluated. Results: A total of 830 hernias were operated upon in 572 patients, aged between 16 and 89 years. Three hundred and twelve patients had the operation as a day-case procedure, and the remaining 260 were treated as inpatients. Incidental hernias were discovered in 19.1% of patients, and were treated simultaneously. Conclusion: The laparoscopic tension-free TAPP method of hernia repair, as done here, is cost-effective and efficacious. Most patients can be treated as day-cases. A low recurrence rate (0.36%) with low morbidity makes it an attractive method for routine treatment of groin hernias in the NHS. [ABSTRACT FROM AUTHOR]

Inguinal hernia repair is one of the most common operations in general surgery with rates of repair ranging from 10 per 10,000 population in the United Kingdom to 28 per 10,000 in the United States. Most inguinal hernias cause mild to moderate discomfort, which increases with activity. Up to one-third of the patients with an inguinal hernia scheduled for surgery have an asymptomatic swelling. Inguinal hernias are a significant socioeconomic burden with direct costs to the health service and indirect costs to the economy due to time off work following operation. In addition, the morbidity associated with the operation is often underestimated. Therefore, it is important to critically review the risks and complications related to inguinal hernia repair in those with minimal symptoms to formulate the best management strategy for these patients. [ABSTRACT FROM AUTHOR]

The article presents consecutive cases relating to claims following elective inguinal hernia repair in Great Britain. Statistics showing the frequency of performing inguinal hernia repairs is provided. Complications specific to hernia repair are identified. It should be noted that there are claims related to recurrence following hernia repair.

The article presents a case review on the medical records of all infants who successively went through preperitoneal inguinal herniotomy between January 1995 to March 2004 in Great Britain. The medical records have described a variety of surgical techniques for pediatric inguinal herniotomy and include the transinguinal approach. However, the preperitoneal approach offers a potential advantage over transinguinal approach by avoiding dissection in the inguinal canal which is safe and simple.

Abstract: In England and Wales, approximately 105,000 people develop inguinal hernias each year, with 10 elective repairs per 10,000 population carried in the UK. The number of inguinal hernia repairs performed in NHS hospitals in England and Wales in 1998/9 was 76,087, of which about 8% were for recurrence. The science of groin herniorrhaphy has evolved greatly over the last twenty years. Since Bassini''s pioneering work in 1887, there have been many developments by surgeons such as Halsted, McVay, Moloney and Shouldice. Their aim was to teach the principles of repair in the hope that the average surgeon might attain acceptable recurrence rates. [Copyright &y& Elsevier]

Focuses the inguinal hernia repair in surgical repairs for patients in Great Britain. Introduction of the tension-free repair and laparoscopic repair; Details on the patient selection and pre-operative preparation; Factors that influence the choice of prosthetic material.

Presents a study which examined the trends in hospital admissions for inguinal hernia surgery in men. Overview of the inequality of access to health care services in Great Britain; Methods; Results and discussion; Conclusions.

The prevalence of inguinal hernia in Ghana, western Africa, is as high as 7.7% of the population. The elective operation rate is significantly lower because many of the hernias are repaired as emergencies. This discrepancy results in a pool of longstanding large hernias. This prospective cohort study compared consecutive patients having day case local anaesthetic inguinal hernia repairs under the Plymouth Hernia Service, UK, and in Ghana, Africa. Assessment was made of hernia size and subscapular skin-fold thickness. In the Ghanaian group, data were collected on patient age, type of inguinal hernia, duration of the hernia, and disability caused. A total of 241 patients were included in the study (UK: n = 106, Ghana: n = 135). The mean age of the UK group was 62 years (range 28–91 years) and of the Ghanaian group 34 years (range 2 months–80 years). One hundred and twelve (82.9%) of the Ghanaian hernias were indirect. Ninety (67%) of the Ghanaian hernias extended into the scrotum compared with 7 (6.0%) in the UK group. The Ghanaian hernias were significantly larger ( P = 0.01) and the patients significantly thinner ( P = 0.02). In the Ghanaian group, 22 (16%) of the patients were unable to work due to their hernia, and in a further 87 (64%) patients, the hernia limited daily activity. One hundred and fifteen (85%) of the Ghanaian hernias were present for more than 1 year, and of those, 50 (37%) had been present for more than 5 years. In Ghana (a developing country), the hernia is larger than the UK hernia. The majority of Ghanaian hernias are indirect and occur in a young population. This places an economic burden on the country. Appropriate management is needed to reduce the pool of these hernias. [ABSTRACT FROM AUTHOR]

Discusses the reluctance of NICE to recommend laparoscopic repair of hernias based on economic considerations. Reference to studies which show laparoscopic herniorraphy is less painful postoperatively than traditional open repair; Why the true costs of laparoscopic repair are lower than those of open repair; Contention that NICE was incorrect in its cost calculations; View that British surgeons are under-represented on NICE's appraisal panel.

Aim: The aim of the study was to evaluate any social, occupational and physical factors, which may influence the occurence or cause of a primary inguinal hernia in two European countries., Methods: A questionnaire was completed by all the respondents in the setting of an out-patient clinic prospectively at the time of initial presentation and the data were collected on a secure database. All responses for each question were explored via appropriate descriptive statistics. Statistical comparisons were made using Fisher's exact test where appropriate., Results: 537 adults completed the questionnaire and had their data analysed. Comparisons between those that presented with a primary complaint of either 'bulge/swelling' or 'discomfort/pain' found no differences in occupation, age or any other demographic data. Equal proportions of patients who described a single strenuous event presented with a bulge/swelling or discomfort/pain. The reporting of a causative single strenuous event was not significantly influenced by occupation, lifestyle or amount of activity carried out nor was there any significant influence upon when a hernia presented after the suspected strenuous event, although the majority reported a lump within 1 week., Conclusion: This study cannot at present support the belief that a single strenuous event will be the sole cause for the development of a primary inguinal hernia.

Purpose: Little is known regarding the magnitude and timing of the risk of VTE following inguinal hernia surgery. We aimed to determine the absolute and relative rates of venous thromboembolism (VTE) following planned inguinal hernia repair., Methods: We analysed male adults with a first inguinal hernia repair with no prior record of VTE from the Clinical Practice Research Datalink, linked to the Hospital Episode Statistics (2001-2011). Crude rates and adjusted hazard ratios (HR) of the first VTE were calculated using Cox regression analysis to compare specific time periods following the surgery compared to the general population., Results: We identified 28,782 men who underwent an inguinal hernia repair with 53 (0.18%) having a first VTE in the 90 days following surgery. The overall rate of VTE in the first 90 days following surgery was 7.61 per 1000 person years (pyrs) (95% CI 5.82-9.96). Increasing age, a body mass index > 30 kg/m 2 and an in-patient procedure were associated with an increased risk of VTE, when compared to the general population. The risk of VTE was highest in the 1st month following the surgery with a 2.3- (aHR 2.33; 95% CI 1.09-4.99) and 3.5- (aHR 3.47; 95% CI 2.07-5.83) fold increased risk compared to the general population for both day case and planned in-patient procedures, respectively., Conclusions: Reassuringly, the absolute rates of VTE following inguinal hernia repair are low. Patients should be informed that their peak risk of VTE is during the 1st month following the surgery. Further studies on the optimum duration of thromboprophylaxis following surgery are required in high-risk patients undergoing hernia repair.

The article presents a legal case of William Fox versus Ashton Leigh & Wigan Primary Care Trust. The Claimant, William Fox had undergo three extra operations because his first inguinal hernia repair failed. Fox sued the Wigan hospital because the surgeries affected his quality of life; judges awarded him general damages of around pound 25,000.00.

The article reports a case court involving a man who suffered injury to the sigmoid colon during hernia repair operation in Great Britain. A report concluded that while a fecal fistula is a recognized complication of inguinal hernia surgery, in this case it was not an acceptable complication and fell below the standard of care that would be expected. Without-prejudice correspondence and discussions resulted in a settlement of £55,000.

Presents the results of a retrospective study on surgical management of inguinal hernia. Report that inguinal hernia repair (IHR) is the most common surgical procedure performed in Great Britain; Design and scope of the study; Report on the number of IHR surgeries performed in Great Britain; Claim that the ratio of recurrent to primary repairs has decreased; View that improved surgical techniques have impacted rates of recurrence.

The article discusses the case of Kitley v Al-Musawi, where the Claimant suffered direct injury to the bladder due to surgical error during laparoscopic repair of a large inguinal hernia. There was substandard delay in diagnosing the bladder damage and subsequent referral to and treatment by a Consultant Urologist. General damages were agreed at 20,000 Pounds Sterling with special damages including Claimant's private medical insurer's outlay totaling 19,448.84 Pounds Sterling.

Questions the benefits of a truss on patients with inguinal hernia in Great Britain. Compliance of the patients in wearing the truss; Surgery as best treatment for groin hernias; Complications of wearing truss.

Focuses on the price instability charged by the National Health Service hospitals in West Midlands. Use of the monitoring unit in determining the destabilizing effect of funholders; Comparison between the cost of inguinal hernia repair in various hospitals; Importance of reforms in referral patterns stability.