The experience and awareness of laparoendoscopic procedures among Polish surgeons in everyday clinical practice.

Abstract

IntroductionIn 2012, a total of 56 647 inguinal hernia repairs were performed in Poland. However, the absence of a uniform hernia repair register obscures the current herniology status in Poland, especially regarding laparoendoscopic procedures.AimTo determine the awareness of laparoendoscopic procedures among Polish surgeons and to ascertain their everyday clinical practice.Material and methodsThe data were collected at the national hernia conference in 2016, during an interactive session for surgeons with a special interest in herniology. They could respond to the survey items using the VoxVote application. All items and response options were displayed on participants’ smartphones. The questions were related to transabdominal preperitoneal/totally extraperitoneal (TAPP/TEP) hernia repair. The surgeons responded to 27 questions regarding routine inguinal hernia repair. One hundred and six surgeons from all regions of Poland participated in the survey.Results19.2% of respondents never inform patients about the possibility of performing laparoendoscopic repair. 45.2% admitted that they had referred a patient with a difficult inguinal hernia to another hospital or surgeon. Seventy-five percent stated they would be willing to perform TAPP/TEP if the reimbursement rates were more favourable. In bilateral hernias, 61.6% of the respondents perform a two-step open repair, while only 25% perform a single-stage laparoendoscopic repair of bilateral hernia. In women, only 13.3% perform laparoendoscopic hernia repairs, and 19.0% do not use mesh.ConclusionsThe skill level to perform TAPP/TEP repair is still inadequate among Polish surgeons. The absence of accurate data makes it impossible to verify whether the treatment methods used are compliant with the guidelines.

Totally extraperitoneal inguinal hernia repair with or without fixation leads to similar results. Outcome of randomized prospective trial.

“…Chronic postoperative pain of more than 3 months is estimated to occur in 2-53% of patients, and the occurrence rate primarily depends on the surgical technique. The chronic pain rate for laparoendoscopic techniques such as totally extraperitoneal approach (TEP) is estimated at approximately 6% (range: 1-16%), which is significantly lower than the rate for tension-free open hernia repair technique of approximately 18% (range: 1-75%) [1][2][3][4][5]. The advantage of TEP-IHR is mainly due to less injury and the dissection and implantation of the implant in the pre-peritoneal space.…”

Factors influencing inguinal hernia symptoms and preoperative evaluation of symptoms by patients: results of a prospective study including 1647 patients

“…It results in a constant evolution of indications for operative treatment, from watchful waiting to surgical treatment of all hernias [2, 3]. Even in patients with no preoperative symptoms, performing a repair is suggested in selected cases, as the symptoms will occur with time, but the decision must be preceded by comprehensive information about the risk of chronic postoperative pain [4].…”

“…Despite the fact that hernias occur commonly, there is still insufficient detailed information regarding the specific symptoms in the natural course of the untreated illness and the risk of developing complications. It results in a constant evolution of indications for operative treatment, from watchful waiting to surgical treatment of all hernias [ 2 , 3 ]. Even in patients with no preoperative symptoms, performing a repair is suggested in selected cases, as the symptoms will occur with time, but the decision must be preceded by comprehensive information about the risk of chronic postoperative pain [ 4 ].…”

Outcome and Complications of Laparoscopic Appendectomy in Almak Nimir University Hospital Shendi University Single Centre Experience, Sudan

“…Initially, the limitations for wider use of this technique were a consequence of surgeons' fear of intra-abdominal abscesses, longer operative time, and higher costs associated with laparoscopy [12]. However, popularization of minimally invasive techniques and access to instrumentation in a number of centers have removed economic and logistical obstacles [13]. Moreover, subsequent studies reported that operative times for the open and laparoscopic approaches are similar for experienced surgeons [12,14].…”