Endoscopic surgeons' preferences for inguinal hernia repair: TEP, TAPP, or OPEN

The use of endoscopic inguinal hernia repair has slowly increased in the past years, but the indications have remained vague. Some surgeons perform a tailored approach depending on patient or hernia characteristics, whereas others perform the same approach and technique for all hernias.

Based on these principles, a survey of 19 questions was conducted during the 18th Congress of the European Association of Endoscopic Surgeons, which took place in Geneva, Switzerland, in 2010, to determine surgeons' preference depending on the hernia and the patient.

All surgeons who attended the session (N = 100) responded to all questions. Eighty two percent of surgeons preferred a tailored approach, whereas 18 % used the same technique in all cases. Endoscopic techniques are used more frequently than the open approach in bilateral (7 vs. 93 %) and recurrent hernias (19 vs. 81 %), whereas in primary unilateral hernias all three techniques were used with almost similar frequency (32 % open, 39 % TAPP vs. 29 % TEP). TAPP was used more frequently than TEP, and even those surgeons who are expert in TEP preferred to perform a TAPP in difficult hernias, such as in obese patients and large scrotal hernias. Based on the age of patients, the open approach is preferred in patients younger than 18 years and older than 70 years, whereas the endoscopic approach is preferred in young active males and females, with a trend to use TAPP (44 %) more frequently than TEP (40 %) in females. Surgeons tended to use the open (vs. endoscopic) approach in patients with hematologic disorders (58 % open vs. 42 % endoscopic), previous laparotomy (59 % open vs. 41 % endoscopic) or emergency surgery (66 vs. 33 % in incarcerated hernias and 74 vs. 26 % in strangulated hernia).

This survey showed that most surgeons who perform an endoscopic approach for inguinal hernia as the first option are convinced that not all hernias are good indications for this approach. On the other hand, most surgeons think that it is better to be able to offer patients an endoscopic technique or an open approach depending on the case.