Resumen

IRIBARREN, Claudio; RIVERA, Alberto  y  RUIZ, Hernán. Inguinal hernioplasty in 2012: Survey from surgeons of the Argentine Association of Surgery. Rev. argent. cir. [online]. 2013, vol.105, n.2, pp.45-51. ISSN 2250-639X.

Background: Inguinal hernia repair has experienced two important changes in the last decades which have gained different acceptance amongst general surgeons: the tension-free techniques with polypropylene meshes and the laparoscopic approach of the repair. In this study we investigated the actual view on the subject in our country amongst the members of the Argentine Association of Surgery (AAC), focusing the survey in the learning of the techniques and the obstacles for its employment related to cost and availability of supplies and equipment, to assess its current indications and the benefits of encouraging its development in the present times. Objective: To analyze the results of a questionnaire performed amongst members of the AAC, regarding the use of polypropylene mesh and the laparoscopic approach in inguinal hernia repair. Population: 559 surgeons, members of the AAC. Methods: A questionnaire was sent by mail to all members of the AAC regarding their indications and frequency of use of a polypropylene mesh and the laparoscopic approach for the treatment of inguinal hernia in the last 3 years, also inquiring about the reasons for not having employed them. The questionnaire was sent again two months later to attain a larger response rate. Some data were crossed amongst the items of the questionnaire to obtain new data emerging from their combination. Results: There was a tendency of more frequent use of the polypropylene mesh, 83.7% of surgeons having employed it in more than 80% of their patients in 2011. Amongst the reasons for not using it, administrative obstacles were pointed out in 26.3% of the responses and lack of experience in 8.7%. The laparoscopic approach remained of limited application, showing a moderate rise in the frequency of its use: 65% of the responders had not performed it in 2011, and few of them had used it in more than 50% of their cases. The laparoscopic approach was clearly more frequently employed (46.4%) amongst the surgeons that performed more than 50 hernioplasties a year. Regarding this technique, administrative obstacles were the reasons for not doing it in 48.3% of the responses and lack of experience in 25.8%, reaching up to 56% amongst surgeons of less than 40 years of age. Bilateral and recurrent hernias stood out clearly as the preferred indications for a laparoscopic hernioplasty, and 45% of the responders expressed an interest in obtaining experience in the laparoscopic technique, through training stays in specialized services or hands-on courses. Conclusions: The great majority of the general surgeons of the AAC has employed the polypropylene mesh for inguinal hernioplasty and this conduct has followed an increased tendency through the last 3 years. Although laparoscopic hernioplasty has also increased in frequency in the last 3 years, 2/3 of the surgeons that answered the questionnaire had not yet performed it in 2011, being the main obstacles administrative reasons and the lack of experience in the technique. Currently, laparoscopic hernioplasty is performed mainly in specialized centers and by those who have a greater number of hernioplasties in their surgical practice. There was a clear interest in young general surgeons of our survey in learning the laparoscopic technique. Consequently, we suggest, as other authors, that an effort should be made to develop its teaching and training and reduce its cost, to offer the surgeon who wishes to employ it the possibility to perform it with a reliable technique.

Palabras clave : Inguinal hernia; Surgery; Survey; Argentina.

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