Physicians' Choice for Their Own Hernia Repairs

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Abstract
While the optimal method of inguinal herniorrhaphy is controversial, there is growing acceptance that laparoscopic hernia repair is a legitimate alternative to conventional techniques. This study sought to determine if physicians as patients had different preferences for their own hernia repairs than nonphysician patients. Total endoscopic preperitoneal (TEP) herniorrhaphy was introduced into the author's practice in 1995. Open herniorrhaphies (OH) were performed under local anesthesia and were almost all tension-free repairs. Patients were given the option of surgical technique after a discussion with the author, although patients with primary unilateral hernias were encouraged to undergo a tension-free OH. A prospective database was kept and subsequently analyzed. In the 3 years from June 1, 1995, to June 1, 1998, a total of 138 OH and 77 TEP repairs were performed. There were 19 physicians among the 215 patients. During the 3-year period, the annual percentage of laparoscopic herniorrhaphies increased from 27% (21/79) to 46% (32/70) (P = 0.024). The shift in physician preference for TEP from 16% (1/6) in 1995 to 75% (6/8) in 1997 was more dramatic than the shift in the population at large: 22% (20/73) to 42% (26/62). All patients undergoing TEP repair for recurrent hernias stated their recovery was easier than after their original OH. Four of seven physicians with recurrent hernias also had bilateral hernias. None required hospitalization. The median time to return to work was 4 days in the TEP physician group and 7 days in the physician OH group. The median time to return to work was 10 days in the TEP nonphysician group and 16 days in the OH nonphysician group. Physicians cared for by the author are increasingly choosing a laparoscopic approach for their hernia repairs even when they have primary unilateral hernias. Patients return to work more rapidly after TEP repairs than after OH.