VOLCANO: Variation of adolescent inguinal hernia operations
PROJECT LEADs:
Sajeed Ali (ST4 Evelina ) and Phoebe Cope (CST Evelina)
Consultant lead Saravanakunmar Paramalingam
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Volcano is now recruiting centres! If you are interested please don't hesitate to get in touch!
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Background​
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There is variation in the surgical management of adolescent inguinal hernias across
centres and surgeons, particularly with regards to the type of repair (closure/ligation of
patent processus vaginalis vs muscle/mesh repair) and the choice of surgical approach
(open vs laparoscopic) (1-4). The variation in practice is exacerbated by this population
being managed by both paediatric and adult general surgeons who demonstrate
diOerences in surgical technique (1,3,5).
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Aim
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To describe the current practice in management of adolescent inguinal hernias in
the UK (adolescence defined as 10-19yrs by the World Health Organisation)
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To identify the proportion of direct versus indirect inguinal hernia in this cohort
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Identify the complication and recurrence rate in adolescent inguinal hernia
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Methods
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On enrolment to the study, participating centres will complete a one-time survey
characterising the inguinal hernia repair pathway and operating surgeon demographics
in their centre. Data collectors will then use REDCap to collect anonymous data for each
inguinal hernia repair carried out during the data collection window (1st August 2019-1st
August 2024).
Data to be captured includes:
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Patient demographics
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Pre-operative data
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Operative details
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Post-operative management
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Ethical approval
This study does not require NHS Research Ethics Committee approval​
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Frequently asked questions:
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Who can participate as a data collector?
• Any doctor or medical student involved in the surgical care of adolescent
patients
• Each site can have a maximum of 3 data collectors
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How do I register to participate in the study?
• Please contact your centre’s audit department to register this national service
evaluation study
• A registration letter of support has been provided to assist in local audit
registration
• Once local site approval has been secured, please complete the ‘Survey of
Participating Centres’ document to register your centres participation in the
study
When can I start collecting data?
• Once local centre approval has been approved, and you have completed the
‘Survey of Participating Centres’ document you can start collecting data
Which patients should be included?
• All adolescent patients (age 10 to 19 years) who underwent inguinal hernia repair
between 1st August 2019 and 1st August 2024 should be included
Collaborative recognition
• All data collectors who contribute to a complete data set for their site will receive
collaborative authorship
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Data Security
• Data collected will be non-identifiable data. Each site will be allocated a number
sequence at the time of recruitment. No data sharing agreement is necessary as
this is not research as per the HRA guidance (https://www.hradecisiontools.org.uk/research/)
• Analysis will not identify individual patients or centres
• There is no need to involve the Caldicott guardian given the use of anonymous
data
Can I present my centres data locally?
• Yes you can present your data locally
Where can I find study updates?
• Study updates will be communicated via email and PSTRN communications
When will the results be published?
• The project leads will collate and analyse the data after all participating centres
have completed their data collection
• Updates on project progress and publication plans will be shared with all
collaborators
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If you are interested in signing up your centre please email Phoebe Cope on phoebe.cope@nhs.net.
You should contact your centre's audit department to register this national service evaluation study.
Once local site approval is granted complete the 'survey of participation centres' document and return this to us.
You will then receive access to REDCap and can start collecting data!
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For more information contact Sajeed Ali at sajeed.ali@nhs.net or Phoebe Cope phoebe.cope@nhs.net.
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Key links:
Survey of Participating centres
VOLCANO Registration letter of support
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References
1. Bruns NE, Glenn IC, McNinch NL, Rosen MJ, Ponsky TA (2017). Treatment of routine
adolescent inguinal hernia vastly diOers between paediatric surgeons and general
surgeons. Surg Endosc. 31(2):912-916
2. Lobe TE, Biano FM (2022). Adolescent inguinal hernia repair: a review of the literature
and recommendations for selective management. Hernia. 26(3):831-837
3. Reistrup H, Fonnes S, Rosenberg J (2023). No reason to Use Mesh in Groin Hernia
Repair in Adolescents. J.Abdom. Wall Surg. 2
4. Reistrup H, Andresen K, Rosenberg J (2023). Low incidence of recurrence and chronic
pain after groin hernia repair in adolescents: a systematic review and meta-analysis.
(2023). Langenbecks Arch Surg. 26;308(1):211
5. Criss CN, Gish N, Gish J et al (2018). Outcomes of Adolescent and Young Adults
Receiving High Ligation and Mesh Repairs: A 16-Year Experience. J Laparoendosc Adv
Surg Tech A. 28(20):223-228
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