[Inguinal hernia repair in TAPP technique in a day-case surgery setting - at what price?]

Chirurg. 2017 Sep;88(9):792-798. doi: 10.1007/s00104-017-0429-9.
[Article in German]


Background: TAPP surgery can be considered as a gold standard in inguinal hernia repair. Patients benefit of a faster reconvalescence and less pain compared to other techniques. TAPP surgery in Germany is performed in an in-patient setting routinely. However, according to European guidelines, inguinal hernia surgery should be considered as day-case surgery whenever possible.

Objectives: The safety of day-case surgery was examined in relation to postoperative pain, complications, comorbidities, recurrent inguinal hernia and bilateral procedures.

Material and methods: In a retrospective, monocentric study we analyzed 522 elective inguinal hernia repairs using TAPP technique in a specialized hernia center. Supplemental data from Herniamed registry is analyzed.

Results: Parts of the procedures should be performed in an in-patient setting, whereas a much larger number of cases should be carried out as day-case surgeries. Logistic regression analyses show that "age", "bilateral procedures" and "comorbidities" affect the complication rate. "Age" and "recurrent inguinal hernia" are risk factors for an increased need for analgetic medication. Furthermore, we present an actual distribution of day-case vs. in-patient surgeries in inguinal hernia repair based on data from the Herniamed registry.

Conclusion: A much larger part of procedures could safely be carried out as day-case surgeries. Based on a false incentive there is an incorrect steering in the German health system. These procedures cannot be carried out covering the costs as day-surgery cases. If there is no reevaluation of the proceeds of these procedures in a day-case surgery setting, the reasonable quality in treatment is compromised especially in inguinal hernia surgery.

Keywords: DRG; Day surgery; Endoscopic hernia surgery; Inguinal hernia; TAPP.

MeSH terms

  • Abdomen / surgery
  • Adult
  • Aged
  • Ambulatory Surgical Procedures / economics
  • Ambulatory Surgical Procedures / methods*
  • Comorbidity
  • Cost Savings / statistics & numerical data
  • Female
  • Germany
  • Guideline Adherence / economics
  • Hernia, Inguinal / economics
  • Hernia, Inguinal / surgery*
  • Humans
  • Male
  • Middle Aged
  • Pain, Postoperative / economics
  • Pain, Postoperative / etiology
  • Peritoneum / surgery
  • Postoperative Complications / economics
  • Postoperative Complications / etiology
  • Recurrence
  • Retrospective Studies