EXPLORING PAKISTANI GENERAL SURGEONS' KNOWLEDGE, ATTITUDE, PRACTICE, AND BARRIERS TOWARD SHOULDICE INGUINAL HERNIA REPAIR: A CROSS-SECTIONAL STUDY.
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Keywords
Hernia, Inguinal surgery, Hernioplasty, Knowledge, Attitudes, Practice, Pakistan.
Abstract
Introduction: The Shouldice repair is effective but declining due to limited training and support. This study aimed to evaluate Pakistani general surgeons’ knowledge, attitudes, practices, and perceived barriers (KAPB) toward the Shouldice inguinal hernia repair technique. Methodology: A cross-sectional, survey-based study was conducted from December 2024 to June 2025 across public and private hospitals in Karachi. General surgeons aged 30–65 years who routinely perform inguinal hernia repairs were included. A self-administered, semi-structured questionnaire, developed through literature review and expert consultation, assessed demographics, knowledge, attitudes, practices, and barriers. Data were collected both online and in person. Associations between demographic characteristics and KAP outcomes were analyzed using Chi-square and Fisher’s exact tests, with effect sizes reported as Cramér’s V or Phi. A p-value ≤0.05 was considered statistically significant Results: Of 420 surgeons approached, 384 were included. While 71.6% reported familiarity with the Shouldice technique, only 22.9% had formal training and 28.1% had ever performed the procedure. Confidence was low (14.3%), with mesh repair predominating (84.6%). The most reported barriers were lack of training (72.1%), limited residency exposure (65.9%), and institutional policies favoring mesh (51.0%). Surgeons older than 40 years, those with >10 years of experience, and fellowship-trained surgeons showed significantly higher knowledge, positive attitudes, and practice rates (all p<0.05).Conclusion: Pakistani surgeons recognize the Shouldice repair’s value but face systemic barriers to its practice. Targeted training, mentorship, and institutional support are essential to preserve this non-mesh option in contemporary hernia repair.
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
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Mehmooda Wasim
Assistant professor, Surgery ,UMDC and creek general hospital, Karachi
Syed Muhammad Shafqatullah
Associate Professor , Surgery ,Jinnah Postgraduate Medical Center, Karachi
Tooba Mahmud Gauhar
Associate Professor of Surgery, Al-Tibri Medical College, Karachi
Shakeel Ahmed
Assistant professor surgery , KMDC, Karachi
Tehreem Ahmed
Senior Registrar,General Surgery,UMDC and creek general hospital, Karachi
Fatima Imran
United Medical and Dental College, Creek General Hospital, Karachi
