Laparoscopic hernioplasty in Mexico: results of a national survey

Abstract

Background: Inguinal hernia repair is one of the most commonly performed procedures worldwide but in most countries, including Mexico, the laparoscopic approach has developed at a slower pace than other surgical techniques. In the absence of a national hernia registry and with the purpose of understanding how laparoscopic inguinal hernia repair stands in our country, we performed a large survey among Mexican surgeons and evaluated different aspects about this minimally invasive procedure. Methods: A structured survey with 40 single and multiple answer questions, using the Survey MonkeyVR (www. surveymonkey.com) platform was conducted from April 2014 to March 2015. The questionnaire was uploaded online in the websites of the two main mexican surgical societies: Asociación Mexicana de Cirugía Endocópica (AMCE), and Asociación Mexicana de Cirugía General (AMCG) during one year, and members were asked to participate voluntarily. A sample size of 968 responses was statistically calculated. Questions analyzed about laparoscopic inguinal hernia repair were focused on training, experience, practice, and availability of the procedure. Results: A total of 1,151 questionnaires were collected. Of those who answered the question about having had training in laparoscopic inguinal hernia repair (LIHR) (74.29%), approximately 53% answered affirmatively. Only 47% of these considered their training adequate. More than half of the respondents had no training during their residency program and only 17% reported as performing more than 10 cases as a surgeon and 31% as an assistant. More than 70% required further training after their residency. Routine practice of LIHR is performed by 26% of respondents while never performed by 32.5%. Approximately 40% wishes to obtain training and more than 70% accept to be limited by lack of training. Conclusions: Our survey shows that laparoscopic inguinal hernia repair has had a very slow development in Mexico, as it has in other countries. The large diversity of surgical care conditions and training opportunities seems to be the most relevant factor. Larger national registry data are required for a better understanding and for better planning of training and availability for this minimally invasive procedure.