[Incisional hernia repair in Germany at the crossroads: a comparison of two hospital surveys in 1995 and 2001].

INTRODUCTION

Incisional hernia repair has become a controversial issue in surgery.

METHODS

To survey the current practice patterns of incisional hernia repair, a questionnaire was mailed to 2 380 surgical departments in Germany. Responses were received from 732 hospitals. The results of the current survey were compared with that of a similar survey performed in 1995.

RESULTS

Overall, the incidence of incisional hernia surgery seems to have markedly increased. An increasing number of operations is performed in specialized large centres. Depending on hernia type (primary hernia < 5 cm, primary hernia > 5 cm, recurrent hernia) mesh materials have gained popularity (15 %, 67 %, and 79 %, respectively) as compared to 1995. Prolene(R) (34 %) and Vypro(R) (25 %) are the currently preferred meshes. The number of hospitals that use non-resorbable suturing material has doubled between 1995 (22 %) and 2001 (45 %). Interrupted suture are no longer the standard technique for fascia closure (80 % in 1995, 50 % in 2001). Autodermal skin graft and laparoscopic hernia repair are of little importance. Although literature data suggest high recurrence rates, most surgeons still expect that only 5-10 % of their primary or recurrent hernia repairs will fail.

CONCLUSIONS

Incisional hernia repair is undergoing radical changes. However, it is unclear whether these changes in surgical techniques and materials were caused by the individual surgeon's clinical expertise, the recent publication of important trials, or the financial circumstances.