Current status of laparoscopic inguinal hernia repair in Denmark

Laparoscopic inguinal hernia repair is becoming more common in many countries, but the quality of care, experience of the operating surgeon, and details of the surgical technique are not known in detail on a national level in Denmark. In a period of expanding surgical volume for laparoscopic inguinal hernia repair, it is important to know the typical indications for surgery, re-operation rates, details of surgical technique, and status of surgical training on a national level in order to rationalize interventions to improve outcome.

Data from the National Hernia Database for the last 8 years regarding laparoscopic inguinal hernia repair were used in combination with questionnaire data obtained from all surgical units in Denmark. The questionnaire included issues such as the number of operating surgeons in the department, number of residents training in the laparoscopic technique, and the experience level of the most experienced surgeon in the department regarding laparoscopic inguinal hernia repair. The questionnaire also included details of the surgical technique.

The frequency of laparoscopic repair has been increasing over the last 8 years and now accounts for about 16% of the total number of inguinal herniorrhaphies with the main indication nationwide being bilateral hernias and recurrent hernias. We found slight variations in surgical technique although all departments used the TAPP repair. The majority used adequate mesh sizes at or above 10 x 15 cm, and most departments used coils or tacks for mesh fixation and peritoneal closure. Fifteen of 25 departments had only one or two surgeons performing laparoscopic inguinal hernia repair and 12 of 25 departments did not have any young surgeons in training for laparoscopic inguinal hernia repair. Ten departments had one surgeon in training, and three departments had two surgeons in training.

Laparoscopic inguinal hernia repair in Denmark is increasing in prevalence. Indications for surgery as well as operative techniques differ although all departments use the TAPP technique. Few surgeons are currently learning the laparoscopic technique, and it is therefore important to initiate meetings and courses to ensure uniform indications for surgery and operative techniques throughout the country.