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. 2025 Apr 19;14(8):2834.
doi: 10.3390/jcm14082834.

Laparoscopic vs. Open-Groin Hernia Repair in Romania-A Populational Study

Nicolae Dragos Garofil  1 , Mihai Zurzu  1 , Mircea Nicolae Bratucu  1 , Vlad Paic  1 , Anca Tigora  1 , Cristian Vladescu  2 , Silviu Badoiu  1 , Victor Dan Eugen Strambu  1 , Petru Adrian Radu  1 , Sandu Ramboiu  3
Affiliations

Laparoscopic vs. Open-Groin Hernia Repair in Romania-A Populational Study

Nicolae Dragos Garofil et al. J Clin Med. .

Abstract

Background/Objectives: Groin hernia repair is a common surgical procedure worldwide, with increasing adoption of minimally invasive techniques. However, the adoption of laparoscopic repair varies significantly across healthcare systems. This study aims to analyze trends in laparoscopic versus open-groin hernia repair in Romania over a five-year period (2019-2023), assessing differences in hospital types, reimbursement policies, and patient outcomes. Methods: This nationwide retrospective study examined 76,553 groin hernia repairs from the National Diagnosis-Related Group (DRG) database, including 231 public and 41 private hospitals. Patients were categorized as laparoscopic (13,282 cases) or open repair (63,271 cases). Statistical analysis included logistic regression and non-parametric tests to assess factors influencing surgical approach selection, hospitalization duration, and case complexity. Results: Laparoscopic repair accounted for 17.3% of all groin hernia procedures, with higher adoption in private hospitals (54.7%) than in public hospitals (14.6%). Laparoscopic procedures increased from 14.1% in 2019 to 20% in 2023. Hospitalization was shorter in private hospitals (1.78 vs. 4.80 days in public hospitals). Reimbursement rates showed minimal differentiation between laparoscopic and open repair, suggesting no financial incentive for minimally invasive surgery in public hospitals. Conclusions: Despite a steady increase in laparoscopic hernia repair, its adoption in Romania remains limited compared to Western Europe. Private hospitals lead in minimally invasive surgery, while public hospitals predominantly rely on open repair due to reimbursement policies and resource constraints. Adjusting DRG-based reimbursement, expanding training, and implementing a national hernia registry could improve outcomes and access to minimally invasive surgery.

Keywords: DRG; groin; hernia; inguinal; laparoscopic repair; minimally invasive surgery; open repair.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Evolution of surgical procedures in public hospitals.
Figure 2
Figure 2
Evolution of surgical procedures in private hospitals.
Figure 3
Figure 3
Distribution of patients undergoing groin hernia repair by age group in public hospitals and the percentage of laparoscopic procedures.
Figure 4
Figure 4
Distribution of patients undergoing groin hernia repair by age group in private hospitals and the percentage of laparoscopic procedures.
Figure 5
Figure 5
Territorial distribution of laparoscopic groin hernia repair case in public hospitals in 2023.
Figure 6
Figure 6
Territorial distribution of laparoscopic groin hernia repair case in private hospitals in 2023.
Figure 7
Figure 7
Evolution of the mean length of stay.
See this image and copyright information in PMC

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