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Laparoscopic vs. Open-Groin Hernia Repair in Romania-A Populational Study
Nicolae Dragos Garofil1, Mihai Zurzu1, Mircea Nicolae Bratucu1
1Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Journal of Clinical Medicine
|April 26, 2025
Summary
Laparoscopic groin hernia repair is increasing in Romania but remains low, especially in public hospitals. Private hospitals show higher adoption, with shorter hospital stays, suggesting policy changes could boost minimally invasive surgery.
Area of Science:
- Surgical Procedures
- Health Services Research
- Medical Economics
Background:
- Groin hernia repair is a common global surgery.
- Minimally invasive techniques like laparoscopic repair are increasingly adopted worldwide.
- Laparoscopic repair adoption varies significantly across different healthcare systems.
Purpose of the Study:
- To analyze trends in laparoscopic versus open-groin hernia repair in Romania from 2019-2023.
- To assess differences in adoption based on hospital type (public vs. private).
- To evaluate the impact of reimbursement policies and patient outcomes on surgical approach selection.
Main Methods:
- Nationwide retrospective study of 76,553 groin hernia repairs using the National Diagnosis-Related Group (DRG) database.
- Inclusion of data from 231 public and 41 private hospitals.
- Statistical analysis using logistic regression and non-parametric tests to compare laparoscopic (13,282 cases) and open repair (63,271 cases).
Main Results:
- Laparoscopic repair constituted 17.3% of procedures, with significantly higher rates in private (54.7%) vs. public (14.6%) hospitals.
- Laparoscopic procedures increased from 14.1% in 2019 to 20% in 2023.
- Shorter hospitalization in private (1.78 days) vs. public (4.80 days) hospitals; minimal reimbursement differentiation between techniques.
Conclusions:
- Laparoscopic hernia repair adoption in Romania is increasing but remains lower than in Western Europe.
- Private hospitals lead in minimally invasive surgery, while public hospitals favor open repair due to policy and resource constraints.
- Recommendations include adjusting DRG reimbursement, expanding training, and establishing a national hernia registry to improve access and outcomes.
