Development of inguinal hernia surgery in the North-Rhine area of Germany

In Germany inguinal hernia surgery has changed over the last decade from co nventional repairs without alloplastic material to video-assisted minimal i nvasive techniques or Lichtenstein repair. Since 1991 every patient undergo ing inguinal hernia repair has been documented in the North-Rhine area in a routine quality-surveillance study. A total of 173,923 patients with 192,7 18 groin hernias (85.26% male and 14.74% female) were operated on. In 1993 the Shouldice repair was performed in 54.2%, the Bassini operation in 26%, the transabdominal laparoscopic TAPP repair in only 3.2% of cases. In 1999 the TAPP repair was performed in 13 %, the extraperitoneal video-assisted T EP repair in 14 %, Lichtenstein repair in 18.5 %, Shouldice repair in 35% a nd the Bassini operation in only 4.8 %. The percentage of operations was 13 .4% over the last 10 years. However, there was an increase from 12.8 % in 1 993 to 14.1 % in 1997, and a rate of 13.5 % in 1999. The following complica tions were observed: hematoma/seroma formation in 3.78 %, wound infection i n 1.15 %, testicular edema in 0.37 % and scrotal edema in 0.64%. The data d ocument the introduction of three new methods for inguinal hernia repair (T APP, TEP and Lichtenstein repair). A decrease in operations on recurrences is not observed.