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Physicians' choice for their own hernia repairs.

D W Rattner1

  • 1Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston 02114, USA. drattner@partners.org

Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
|May 4, 2000
PubMed
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Physicians increasingly prefer laparoscopic hernia repair (total endoscopic preperitoneal - TEP) over open surgery (OH). TEP repairs lead to faster return to work for both physicians and non-physicians.

Area of Science:

  • Surgical Innovation
  • Minimally Invasive Surgery
  • Hernia Repair Techniques

Background:

  • Laparoscopic hernia repair is gaining acceptance as an alternative to conventional methods.
  • Optimal surgical approach for inguinal herniorrhaphy remains a subject of debate.
  • Physician preferences for their own surgical procedures may differ from the general patient population.

Purpose of the Study:

  • To investigate whether physicians, as patients, exhibit different preferences for hernia repair compared to non-physician patients.
  • To analyze the adoption rate and patient outcomes for laparoscopic versus open inguinal herniorrhaphy.

Main Methods:

  • Prospective database analysis of 215 patients undergoing inguinal herniorrhaphy between June 1995 and June 1998.
  • Comparison of total endoscopic preperitoneal (TEP) herniorrhaphy with open herniorrhaphy (OH) under local anesthesia.

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  • Patient choice of surgical technique was offered after discussion, with a preference for tension-free OH for primary unilateral hernias.

    • Main Results:

    • A total of 138 OH and 77 TEP repairs were performed; 19 patients were physicians.
    • The annual percentage of TEP repairs increased significantly from 27% to 46% (P=0.024) over the study period.
    • Physicians showed a more dramatic shift towards TEP (16% to 75%) compared to the general patient population (22% to 42%).
    • Median return to work was faster for TEP (4 days for physicians, 10 days for non-physicians) versus OH (7 days for physicians, 16 days for non-physicians).

    Conclusions:

    • Physicians are increasingly opting for laparoscopic (TEP) hernia repair, even for primary unilateral hernias.
    • Laparoscopic hernia repair (TEP) results in a more rapid return to work compared to open herniorrhaphy (OH).
    • TEP offers a favorable recovery profile, particularly for recurrent or bilateral hernias, with no reported hospitalizations in this cohort.