The experience and awareness of laparoendoscopic procedures among Polish surgeons in everyday clinical practice

Abstract

Introduction: In 2012, a total of 56 647 inguinal hernia repairs were performed in Poland. However, the absence of a uniform hernia repair register obscures the current herniology status in Poland, especially regarding laparoendoscopic procedures.

Aim: To determine the awareness of laparoendoscopic procedures among Polish surgeons and to ascertain their everyday clinical practice.

Material and methods: The data were collected at the national hernia conference in 2016, during an interactive session for surgeons with a special interest in herniology. They could respond to the survey items using the VoxVote application. All items and response options were displayed on participants' smartphones. The questions were related to transabdominal preperitoneal/totally extraperitoneal (TAPP/TEP) hernia repair. The surgeons responded to 27 questions regarding routine inguinal hernia repair. One hundred and six surgeons from all regions of Poland participated in the survey.

Results: 19.2% of respondents never inform patients about the possibility of performing laparoendoscopic repair. 45.2% admitted that they had referred a patient with a difficult inguinal hernia to another hospital or surgeon. Seventy-five percent stated they would be willing to perform TAPP/TEP if the reimbursement rates were more favourable. In bilateral hernias, 61.6% of the respondents perform a two-step open repair, while only 25% perform a single-stage laparoendoscopic repair of bilateral hernia. In women, only 13.3% perform laparoendoscopic hernia repairs, and 19.0% do not use mesh.

Conclusions: The skill level to perform TAPP/TEP repair is still inadequate among Polish surgeons. The absence of accurate data makes it impossible to verify whether the treatment methods used are compliant with the guidelines.

Keywords: groin hernia; inguinal hernia; laparoscopic repair; recommendations; totally extraperitoneal; transabdominal preperitoneal.

Figure 1

Voting surgeons’ population depending on their age (n = 105)

Figure 2

Number of inguinal hernia repairs performed annually (n = 103)

Figure 3

Types of hernia repair performed as the first- or the second-choice technique (n = 105)

Figure 4

Types of repair for bilateral inguinal hernias (n = 104)

Figure 5

Types of hernia repair in women: inguinal (n = 105) and femoral (n = 104)

Figure 6

How many times the cost of a flat mesh for open repair exceeds the cost of a mesh with the same technical parameters used for TAPP/TEP repair (n = 103)

Figure 7

How many times the cost of disposable absorbable tacks exceeds the cost of sutures used for mesh fixation (n = 106)

Figure 8

Types of mesh fixation in TAPP/TEP (n = 35)