title: A survey of general surgeons regarding laparoscopic inguinal hernia repair: practice patterns, barriers, and educational needs.
abstract: OBJECTIVE
  Practice patterns for inguinal hernia repair vary significantly among surgeons. The purpose of this study was to identify perceived indications for laparoscopic inguinal hernia repair (LIHR), and to identify barriers to its adoption and educational needs for surgeons.
  
  
  METHODS
  A web-based survey was sent to general surgery members of several North American surgical societies, and to surgical residents through program directors. The 33-item survey was divided in 4 sections: demographics, utilization of techniques, management based on 11 clinical scenarios, reasons for not performing LIHR and educational needs for those who want to learn.
  
  
  RESULTS
  Six hundred and ninety-seven general surgeons and 206 general surgery residents responded to the survey. Surgeons with MIS fellowships, and surgeons at the beginning of their careers are more likely to perform LIHR. Out of the 11 clinical scenarios, surgeons preferred a laparoscopic approach (totally extraperitoneal or transabdominal preperitoneal) for bilateral (48 %) and recurrent (44 %) hernias. However, 46 % of respondents never perform LIHR. Of these, 70 % consider the benefits of laparoscopy to be minimal, 59 % said they lack the requisite training, and 26 % are interested in learning. Surgeons (70 %) and residents (73 %) agreed that the best educational method would be a course followed by expert proctoring.
  
  
  CONCLUSIONS
  Surgeons remain divided on the utility of laparoscopic surgery for inguinal hernia repair. Nearly half of responding surgeons never perform LIHR, and the other half offer it selectively. One quarter of surgeons who do not perform LIHR are interested in learning. This reveals a knowledge gap that could be addressed with educational programs.
authors: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, McGill University, 1650 Cedar Avenue, L9. 313, Montreal, QC, H3G 1A4, Canada.
authors: M
authors: M
authors: Trevisonno
authors: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, McGill University, 1650 Cedar Avenue, L9. 313, Montreal, QC, H3G 1A4, Canada.
authors: P
authors: P
authors: Kaneva
authors: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, McGill University, 1650 Cedar Avenue, L9. 313, Montreal, QC, H3G 1A4, Canada.|Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Y
authors: Y
authors: Watanabe
authors: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, McGill University, 1650 Cedar Avenue, L9. 313, Montreal, QC, H3G 1A4, Canada.
authors: G M
authors: GM
authors: Fried
authors: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, McGill University, 1650 Cedar Avenue, L9. 313, Montreal, QC, H3G 1A4, Canada.
authors: L S
authors: LS
authors: Feldman
authors: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, McGill University, 1650 Cedar Avenue, L9. 313, Montreal, QC, H3G 1A4, Canada.
authors: E
authors: E
authors: Lebedeva
authors: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, McGill University, 1650 Cedar Avenue, L9. 313, Montreal, QC, H3G 1A4, Canada. melina.vassiliou@mcgill.ca.
authors: M C
authors: MC
authors: Vassiliou
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D013502:General Surgery / Q000193:education*; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000193:education / Q000379:methods; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000009:adverse effects / Q000193:education / Q000379:methods; D008297:Male; D008505:Medical Staff, Hospital; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires
keywords: General surgery/education; Inguinal hernia surgery; Laparoscopy/methods/utilization; Questionnaires