Many patients undergone laparoscopic herniorrhaphy in my country. And it is popular in tehran. But unfortunately its relapse is higher than conventional inguinal herniorrhaphy.
May be, because its more costly, learning curves are more and time consuming and proceedure that can be done in regional or local anesthesia has to be done in general anaesthesia.
It's a common procedure in Kerala. It takes longer to master the technique and if repaired by a skilled surgeon the recurrence rate should be the same as open repair.
Abdominal Wall layers are accessible easily in open surgery. The cost of laparoscopic surgery for an easily accessible organ or structure may not be justifiable to the customer unlike access to Gall bladder or other intra-abdominal organs. So accessibility, cost and direct vision / magnification are the factors leading to less popularity of endoscopic surgery in abdominal wall surgery.
Laparoscopic Inguinal hernia surgery reguires more advanced skills in laparoscopy. Results can be excellent in experianced hands.
In our country in general the reason is that open hernia has lower short term cost than laparoscopic procedure (despite its clear advantages in less long term and social costs with a shorter recovery period)
in my opinion i don' see any convincing cause , may be due to resource issues , learning curve , but eventually every laparoscopic operation happening nowadays was faced with such difficulties in the past , for example : laparoscopic cholecystectomy and appendicectomy , so i think it,s just a matter of time
It is a difficult learning curve and there are more relapses compared with the open surgery
The laparoscopic route is obviously better. It is not necessary to cover our eyes to understand that the problem is profesional competition and performance rather than cost problems.
It would be very convenient to perform a comparative study between several centers
Laparoscopic hernia surgery looks more fashionable than of real benefit to the patient!
Having worked both in the East and West and having seen the cost-benefit analysis alter as procedures get embedded, I would like to add the following, which a number of colleagues will not like
1. The West ensures appropriate training before one commences independent practice and results are continously vetted and validated.
2. If a technique is proven to be beneficial, with increased numbers, costs come down such that eventually taking into account the cost to the patient, there is a cost benefit to laparoscopic procedure.
3. India in particular does not have reliable, long-term outcome data making comparative cross-National studies meaningless.
4. I have made this point a number of times before: surgeons are not technicians; it is imperative that one picks the right procedure for the right patient for the right reasons. It is 7nacceptavle to perform a procedure solely because that is what patients request, if one’s results are worse than an open technique. Frankly, the results of properly performed laparoscopic surgery are at least as good but ususally better than open surgery. Do not accept anything less than that!
5. The advantages to the patient are multi fold! Less pain, less (if any) opioid requirement, less morbidity, early discharge and vitally, earlier return to work being just a few obvious advantages.
6. This is immediately obvious in incisional hernia repairs. Often, the ”complications” here are due to missed iatrogenic injuries or use of incorrect meshes.
All-in-all even if one considers surgeons to be no more than mere technicians, poor/ sub-optimal results would be equivalent to carpenters blaming their tools!
Please operate ethically, safely and within one’s remit!
For our country Senegal in west Africa we adopt laparoscopic procedure for duodenal ulcer, pyloro-duodenal stenosis for complicated ulcer, gallblader lithiasis, mega-oesophagus, gastro-oesophagal reflux. Bariatric surgery is also made by one collegue.
But its soo expansive for poor populations and also time consuming for verification of material and installation by non-motived person. We have the same dilem for appendicectomy, after a few years with mini-invasive procedure we return to open surgery for emergencies.
Sincerly yours. JMN
There is nothing to regret if one continues with the open technique for hernias & appendix. One can reach his destination by travelling in economy class if he cannot afford business class. God forbid, if the plane crashes, passengers of both classes meet the same fate!
The advantages of laparoscopic, and recently robotic, surgery in abdominal field are much higher than disadvantages. In terms of pot-operative pain, length of hospitalization and early return to work. However, recurrence rate ,in some centers, is higher in laparoscopic surgery due to either insufficient experience orlack of appropriate instruments.
Dr ankit and Dr kamal narrated well.Hernia is a different Ball game because all hernias are not the same.Even though I perform all hernias laparoscopically, Hernia surgery is comaratively more demanding,So choose an appropriate technique to get results.
It takes a long time to train and have a lot of prepared surgeons needed to do this technique
Compared with open technique, training in laparoscopic technique could be better organised and standardised
.
It is a difficult and laborious technique that need to be learned as early as possible in the formative carrier of a surgeon
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