Current opinions about laparoscopic incisional hernia repair: a survey of practicing surgeons

Incisional hernias are common. Optimal repair is one of the most analyzed and debated topics; however, there is no consensus as to the appropriate surgical technique.

An Institutional Review Board-approved protocol was designed using an Internet-based survey site (www.surveymonkey.com) to assess practices and opinions regarding incisional hernia repair.

Of 766 surgeons, 204 (27%) responded. Most respondents practice in an academic, urban hospital, and 85% to 96% perform basic laparoscopic procedures. The median percentage of laparoscopic versus total hernia repair was <10%. Use of the laparoscopic technique was associated with a higher volume of hernia repair (r(Spearman's) = .315, P = .001), concurrent advanced laparoscopic experience (z(Wilcoxon rank sum) = -2.348, P = .019), and completion of a laparoscopic fellowship (z(Wilcoxon rank sum) = -3.317, P = .001). When asked how many would start to perform laparoscopic hernia repair, 81% indicated "no." In that group, 52% indicated that a lack of improved results was the main reason, followed by risk of enterotomy > operative time > cost > experience. Those who would start indicated that the main reason was patient request (54%). Among those that use the laparoscopic technique, 85% indicated that they would perform more of these surgeries. The main reason for this was a lower recurrence rate (42%).

There continues to be a lack of consensus on the most appropriate method of repairing incisional hernias. Surgeons having experience with advanced laparoscopic techniques, laparoscopic fellowship training, and higher volume of hernia repair are more likely to use the laparoscopic approach.