In the United States, inguinal hernias and femoral hernias have been treated on an outpatient basis in most cases (92%) for decades now. Even in the former German Democratic Republic, the importance of outpatient surgery was recognized, and in the Veneto province in Italy, the proportion of outpatient operations has risen to comparable levels (1). Only in unified Germany, 66.78% of inguinal hernia repairs are undertaken as inpatient procedures and only 33% on an outpatient basis, according to Jähne (2). Nimptsch and Mansky (3) conclude that death rates for inpatient herniotomies could be lowered. Possible causes of death include complications (perforation, repeat laparotomies, suture failure) that have been described especially in the context of laparoscopic procedures. Recent national registry studies from Scandinavia (4) have confirmed that laparoscopic herniotomies have a higher risk for severe complications than open herniotomies: an extra-abdominal condition turns into an intra-abdominal condition. In view of the fact that in our neighboring countries (the Netherlands, United Kingdom, Denmark, Sweden) the frequency of laparoscopic operations is lower than in Germany, the question that arises is what distinguishes German patients from those of other countries? When taking into consideration the overall economic efficiency of our hospitals, of the complications, and of death rates—maybe less would be more?
Prof. Dr. med. René G. Holzheimer
Praxisklinik Sauerlach, email@example.com
Conflict of interest statement
The author declares that no conflict of interest exists.
|1.||Saia M, et al.: Increased rate of day surgery use for inguinal and femoral hernia repair in a decade of hospital admissions in the Veneto Region (north-east Italy): a record linkage study. BMC Health Services Research 2013; 13: 349. CrossRef MEDLINE PubMed Central|
|2.||Jähne J: Chirurgie der Leistenhernie. Der Chirurg 2010; 72: 456–71 CrossRef CrossRef|
|3.||Nimptsch U, Mansky T: Deaths following cholecystectomy and herniotomy—an analysis of nationwide German hospital discharge data from 2009 to 2013. Dtsch Arztebl Int 2015; 112: 535–43 VOLLTEXT|
|4.||Kouhia S, Vironen J, Hakala T, Paajanen H: Open mesh repair for inguinal hernia is safer than laparoscopic repair or open non-mesh repair: a nationwide registry study of complications. World J Surg 2015; 39: 1878–84 CrossRef MEDLINE|