Abstract
Purpose
The selection of a laparoscopic approach for inguinal hernias varies among surgeons. It is unclear what is being done in actual practice. The purpose of this study was to report practice patterns for treatment of inguinal hernias among Quebec surgeons, and to identify factors that may be associated with the choice of operative approach.
Methods
We studied a population-based cohort of patients who underwent an inguinal hernia repair between 2007 and 2011 in Quebec, Canada. A generalized linear model was used to identify predictors associated with the selection of a laparoscopic approach.
Results
49,657 inguinal hernias were repaired by 478 surgeons. Laparoscopic inguinal hernia repair (LIHR) was used in 8 % of all cases. LIHR was used to repair 28 % of bilateral hernias, 10 % of recurrent hernias, 6 % of unilateral hernias, and 4 % of incarcerated hernias. 268 (56 %) surgeons did not perform any laparoscopic repairs, and 11 (2 %) surgeons performed more than 100 repairs. These 11 surgeons performed 61 % of all laparoscopic cases. Patient factors significantly associated with having LIHR included younger age, fewer comorbidities, bilateral hernias, and recurrent hernias.
Conclusion
An open approach is favored for all clinical scenarios, even for situations where published guidelines recommend a laparoscopic approach. Surgeons remain divided on the best technique for inguinal hernia repair: while more than half never perform LIHR, the small proportion who perform many use the technique for a large proportion of their cases. There appears to be a gap between the best practices put forth in guidelines and what surgeons are doing in actual practice. Identification of barriers to the broader uptake of LIHR may help inform the design of educational programs to train those who have the desire to offer this technique for certain cases, and have the volume to overcome the learning curve.
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Acknowledgments
The Steinberg-Bernstein Centre for Minimally Invasive Surgery at McGill University is supported by an unrestricted educational grant from Covidien Canada. Salary support was also provided by the Mitacs-Accelerate program for the first author.
Conflict of interest
M. Trevisonno declares conflict of interest directly related to the submitted work. Salary support was provided by an unrestricted educational grant from Covidien Canada and from the Mitacs-Accelerate program. No conflict of interest with regards to the results of this study. P. Kaneva declares conflict of interest directly related to the submitted work. Salary support was provided in part by an unrestricted educational grant from Covidien Canada. No conflict of interest with regards to the results of this study. Y. Watanabe declares conflict of interest directly related to the submitted work. Salary support was provided by an unrestricted educational grant from Covidien Canada. No conflict of interest with regards to the results of this study. G. Fried, L. Feldman, A. Andalib, M. Vassiliou declare no conflict of interest.
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Trevisonno, M., Kaneva, P., Watanabe, Y. et al. Current practices of laparoscopic inguinal hernia repair: a population-based analysis. Hernia 19, 725–733 (2015). https://doi.org/10.1007/s10029-015-1358-5
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DOI: https://doi.org/10.1007/s10029-015-1358-5