Patient perception of laparoscopic versus open mesh repair of inguinal hernia, the hard sell

Inguinal hernia repairs are one of the most commonly performed procedures in the UK. This study examined the adequacy of the consent process for inguinal hernia repair focusing on the patients' understanding of the relative risks and benefits of laparoscopic versus open repair.

The study consisted of a retrospective postal questionnaire poll of 200 patients (162 males and 38 females) aged between 42 and 85 who had been assessed in the surgical outpatients (within the last 12 months) and received counselling regarding their inguinal hernia repair. Patient perception regarding the risks and merit of laparoscopic versus open repair was surveyed using a multiple-choice questionnaire.

One hundred and twenty patients (60 %) returned their questionnaires, after excluding recurrent and bilateral hernias; 97 patients were entered into the study. The majority of patients reported a perception that a laparoscopic repair was safer and quicker than open (61.5 and 75.4 %, respectively); 29.2 % of patients felt that the recurrence rate was lower with a laparoscopic repair with 50.8 % of patients expressing that open repair had a higher complication rate than laparoscopic treatment; 81.5 % of patients correctly appreciated that laparoscopic repair had a quicker return to work; and 76.9 % of patients felt that laparoscopic repair was the only method, which could be undertaken as a day case procedure.

The results show that many patients have an incorrect perception of laparoscopic inguinal hernia repair, which may reflect an inadequate consent and counselling process. No definitive evidence exists regarding the superior safety and efficacy of one method over another, but it would appear that a significant number of patients are unaware of this.