The Recurrence Rate in Hernia Surgery

Abstract

In 1891, William Bull, one of this country's most prominent surgeons, wrote of hernia repairs, "It is wise to... estimate the value of given procedures by the relative proportion of relapses."¹ One year later, William Halsted trumpeted Bull's comment when he presented hernia surgery outcomes solely in terms of recurrence rates: "Bassini failed but seven times in 251 cases.... It is now nearly four years that I have been operating for the cure of inguinal hernia... and thus far I have no failure to record."² Halsted showed neither a consequential regard for nor an appreciation of other surgical outcome measures. Specifically, the questions of short- and long-term postoperative discomfort and ability to return to daily activities and work never entered into his evaluation of hernia repair techniques. Such thinking was most evident in Halsted's discussion of an 1895 article by Christian Fenger on groin hernia: "Three weeks