title: Current practices of laparoscopic inguinal hernia repair: a population-based analysis.
abstract: OBJECTIVE
  The selection of a laparoscopic approach for inguinal hernias varies among surgeons. It is unclear what is being done in actual practice. The purpose of this study was to report practice patterns for treatment of inguinal hernias among Quebec surgeons, and to identify factors that may be associated with the choice of operative approach.
  
  
  METHODS
  We studied a population-based cohort of patients who underwent an inguinal hernia repair between 2007 and 2011 in Quebec, Canada. A generalized linear model was used to identify predictors associated with the selection of a laparoscopic approach.
  
  
  RESULTS
  49,657 inguinal hernias were repaired by 478 surgeons. Laparoscopic inguinal hernia repair (LIHR) was used in 8 % of all cases. LIHR was used to repair 28 % of bilateral hernias, 10 % of recurrent hernias, 6 % of unilateral hernias, and 4 % of incarcerated hernias. 268 (56 %) surgeons did not perform any laparoscopic repairs, and 11 (2 %) surgeons performed more than 100 repairs. These 11 surgeons performed 61 % of all laparoscopic cases. Patient factors significantly associated with having LIHR included younger age, fewer comorbidities, bilateral hernias, and recurrent hernias.
  
  
  CONCLUSIONS
  An open approach is favored for all clinical scenarios, even for situations where published guidelines recommend a laparoscopic approach. Surgeons remain divided on the best technique for inguinal hernia repair: while more than half never perform LIHR, the small proportion who perform many use the technique for a large proportion of their cases. There appears to be a gap between the best practices put forth in guidelines and what surgeons are doing in actual practice. Identification of barriers to the broader uptake of LIHR may help inform the design of educational programs to train those who have the desire to offer this technique for certain cases, and have the volume to overcome the learning curve.
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, McGill University, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Trevisonno
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, McGill University, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Kaneva
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, McGill University, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada.|Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, McGill University, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada.
authors.forename: G M
authors.initials: GM
authors.lastname: Fried
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, McGill University, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada.
authors.forename: L S
authors.initials: LS
authors.lastname: Feldman
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, McGill University, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Andalib
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, McGill University, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada. melina.vassiliou@mcgill.ca.
authors.forename: M C
authors.initials: MC
authors.lastname: Vassiliou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006552:Hernia, Inguinal / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D011792:Quebec / Q000453:epidemiology; D055815:Young Adult
keywords: Database; Inguinal hernia surgery; Laparoscopy; Utilization