7 Implementation and audit

7 Implementation and audit

7.1 When NICE recommends a treatment 'as an option', the NHS must make sure it is available within 3 months of this guidance being published. This means that, if the doctor responsible for a patient's care thinks that laparoscopic surgery is the right treatment for the repair of inguinal hernia, it should be available for use, in line with NICE's recommendations.

7.2 Surgical services in NHS organisations should review their current practice and policies relating to repair of inguinal hernia to take account of the guidance set out in Section 1.

7.3 Local guidelines or care pathways for people who undergo surgery for repair of inguinal hernia should incorporate the guidance, considering the availability of a surgeon who is trained and experienced in laparoscopic surgery for the repair of inguinal hernia.

7.4 To measure compliance locally with the guidance, the following criteria could be used. Further details on suggestions for audit are presented in Appendix C.

7.4.1 Laparoscopic surgery is considered as one of the treatment options for the repair of inguinal hernia. In choosing between open and laparoscopic surgery (either the TEP or TAPP procedures), the following are considered:

  • the suitability of the individual for general anaesthesia

  • the nature of the presenting hernia

  • the suitability of the particular hernia for a laparoscopic or open approach

  • the experience of the surgeon in the three techniques.

7.4.2 The individual undergoing repair of inguinal hernia is fully informed of all the risks and benefits associated with open surgery and laparoscopic surgery by both the TEP and TAPP procedures as part of the informed consent process.

7.4.3 Laparoscopic surgery for inguinal hernia repair by TAPP or TEP is performed only by a surgeon who has received appropriate training and regularly carries out the procedure.