The role of laparoscopy in the management of groin hernia

Abstract

Introduction: The advantage of using minimally invasive techniques over open techniques in the repair of groin hernias is still debated. Despite its more widespread use, an apparent dichotomy exists. While some surgeons continue to believe that no advantage is gained using the laparoscopic technique, others argue laparoscopic hernia repair (LHR) offers a quicker recovery with the use of a tension-free repair.

Methods: A mailing to the general surgeon members of the Society of Laparoendoscopic Surgeons, an international multidisciplinary laparoendoscopic society, was performed (mailing size = 1680).

Results: Nine hundred and ninety-three surgeons responded (60%). Across all demographic variables, 60% of respondents performed approximately 27% of their hernia repairs laparoscopically (40% of respondents did not perform LHR). Surgeon age less than 45 was the only demographic characteristic that predicted the likelihood to perform LHR (p < 0.0001) and the percentage of hernias repaired laparoscopically (p < 0.005). Most respondents felt that the presence of bilateral hernias (73%) or a recurrent hernia (74%) were indications for LHR. Eighty-nine percent of respondents felt that LHR would still be performed 20 years from now. Surgeons expressed concerns regarding increased cost, the need for more anesthesia, and a lack of long-term follow-up for LHR.

Conclusions: Only surgeon age predicted the likelihood of a surgeon performing LHR or the percentage of hernias that would be repaired laparoscopically.

Figure 1.

Histogram of surgeon responses to statements about LHR: (1) LHR takes too long to perform; (2) There are unnecessary risks associated with the use of mesh; (3) There is a lack of long term followup for LHR; (4) LHR costs too much when compared to other herniorrhaphies; (5) Anesthetic considerations are greater for LHR; (6) There is no benefit of LHR over other herniorrhaphies.