[Experiences from more than 2,100 hernia repair operations. How has the therapy changed in the last 15 years?].
BACKGROUND
Inguinal hernia (IH) surgery has changed fundamentally during the last 25 years due to tension-free repair, minimally-invasive approaches and growing influence of economy in medical decision making. Aim of the study was the documentation and analysis of changes in IH surgery during the last 15 years in our patient cohort.


METHODS
Patients undergoing elective or emergency inguinal/femoral hernia repair from January 1995 to December 2009 were included in the study. Analysis of patient data was carried out by prospective online recording.


RESULTS
A total of 1,908 patients with 2,124 IHs were treated in the study period and the number of IH repairs decreased continuously. The number of recurrent hernias peaked in 2005-2009 with 16.4%. The average preoperative hospital stay decreased from 2.4 to 0.4 days and the postoperative hospital stay from 7.0 to 3.3 days. The percentage of suture repairs declined from 54.9% in 1995 to 4.1% in 2009 and the percentage of open tension-free repairs rose to 52.9% in 1998. In the following years the majority of repairs were performed by minimally invasive procedures but in 2009 the percentage of conventional hernia repairs exceeded the rate of minimally invasive repairs.


CONCLUSIONS
The main reason for these changes is the implementation of diagnosis-related groups which hampers inpatient repair of "simple" inguinal hernias, favors short hospital stay and does not adequately reimburse minimally invasive repairs.
Lauscher
J C
JC
Klinik für Allgemein-, Gefäß- und Thoraxchirurgie, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, Berlin, Germany. johannes.lauscher@charite.de
Buhr
H J
HJ
Gröne
J
J
Ritz
J P
JP
D019072:Antibiotic Prophylaxis / Q000639:trends; D001672:Biocompatible Materials; D003430:Cross-Sectional Studies; D003953:Diagnosis-Related Groups / Q000639:trends; D005544:Forecasting; D005858:Germany; D006550:Hernia, Femoral / Q000453:epidemiology / Q000601:surgery*; D006552:Hernia, Inguinal / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000639:trends; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data / Q000639:trends*; D009313:National Health Programs / Q000639:trends; D011446:Prospective Studies; D012008:Recurrence; D012051:Reimbursement Mechanisms / Q000639:trends; D012086:Reoperation / Q000639:trends; D013526:Surgical Mesh / Q000706:statistics & numerical data / Q000639:trends; D013536:Suture Techniques / Q000639:trends*; D014600:Utilization Review
D001672:Biocompatible Materials