Decreasing use of open procedures in elective inguinal hernia surgery

Background: There is a change in the use of surgical methods for the repair of inguinal hernias. In Denmark, the national guidelines recommend either the Lichtenstein or the laparoscopic repair. The laparoscopic repair has gained popularity over the last years. The aim of the current study was to report trends in techniques for the repair of elective inguinal hernias, with focus on the Lichtenstein repair, the laparoscopic repair, and reoperation rates. Methods: This cohort study was based on data from the Danish Inguinal Hernia Database from January 1, 1998, until December 31, 2019. The outcome in this study was trends in the use of surgical methods for the repair of groin hernias in Denmark. Results were divided on patients with unilateral and bilateral groin hernia repairs. Patients were also divided into six groups depending on which year they were operated. The first group consisted of patients operated from 1998 to 2002, the second group was operated from 2003 to 2006, the third group from 2007 to 2010, the fourth group from 2011 to 2014, and the last group was operated from 2015 to 2019. Results: In total 173,302 patients initially operated electively for a groin hernia were included. There were several different methods being used for unilateral hernia repairs; however, there seems to be fewer methods in use compared with earlier. The laparoscopic repairs accounted for 96% of the bilateral inguinal hernias and 51% of the unilateral hernias. There has been a decrease in the use of the Lichtenstein method through the years. After 2017, the majority of patients received a laparoscopic repair for a primary unilateral inguinal hernia. Conclusions: In conclusion, this study demonstrated that over the last 21 years there has been an increase in the use of laparoscopic repair for bilateral inguinal hernia that now covers almost 100%. For primary unilateral hernias, the laparoscopic approach is increasingly being used now covering more than half of the operations. Basic surgical training might need to include laparoscopic repair of inguinal hernias in the future.