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INGUINAL HERNIA
Initially, your doctor may want you to simply monitor your hernia for possible complications if you only experience minimal symptoms. This approach is called ‘watchful waiting’. However, in many cases, patients will still have to undergo surgical repair later as the hernia will not get better without surgery.
The need for surgery will depend on the size of your hernia and the severity of your symptoms.
The good thing is that hernia repair surgery has been around for a long time. That means traditional techniques have been refined and alternative options have been developed. While not every technique is right for every hernia, they all have some common goals: to provide the strongest repair and least chance of recurrence with minimal discomfort and quick recovery. The two types of hernia repair surgery are: open repair and laparoscopic repair.
An incision, ranging from 5cm – 10cm, is made through the abdominal wall near the site of the hernia defect. The hernia is repaired with mesh or by suturing (sewing) the muscle closed.
This method has been used historically and may be the only way to repair a very large hernia. The incision can potentially cause pain and recovery can take as long as five to six weeks.1 A scar is also left behind although it is usually very low down on the abdomen.
Laparoscopic repair entails inserting special instruments through small incisions in the abdomen (typically three or four 6mm – 13mm incisions) through which the surgeon is able to visualise and perform the procedure. As such, this procedure is sometimes referred to as ‘keyhole surgery’.
Laparoscopic repair uses mesh for reinforcement. Provided that resources and expertise are available, laparoscopic endoscopic techniques may have faster recovery times, lower chronic pain risk, and are cost effective.2
Mesh repair (also known as non-tension repair) means just that – instead of pulling the tissue around the hernia together, a piece of mesh is positioned to reinforce the area and fixed in place with sutures and/or staples. The mesh is made of a flexible material that stays in the abdomen and encourages new tissue to grow into it. There are different kinds of mesh including patches, three-dimensional, expanding, self-absorbing, and self-gripping mesh that requires few to no sutures to keep it in place.3
A mesh-based repair technique is recommended for patients with symptomatic inguinal hernias.2,4
Robotic surgery, also called robot-assisted surgery (RAS), is a surgery that involves small incisions that allows doctors to perform many types of surgical procedures with more control and precision through the use of wristed instruments and enhanced 3D vision.5
Recently, robotic surgery for inguinal hernia repair has seen increasing use as access to this emerging technology improves, and techniques specific to hernia repair are developed. The use of robotic surgery for hernia procedures in Australia is still limited, however, and availability is highly dependent on the hospital and surgeon performing your procedure.
It should be noted, that while the clinical evidence for robotic and minimally invasive surgical procedures have shown improvements in surgical outcomes vs open surgery,6-8 the data relating to RAS and its benefit for hernia surgery is still evolving as the technology continues to advance and more evidence is collected. 9
There are inherent risks and potential complications associated with all surgery. Ensure that you discuss with a surgeon the benefits and risks of a surgical repair. An operation is the only way to repair a hernia. Typically, patients can return to normal activities and in most cases will not have further discomfort.
Possible risks include:
Make sure to also discuss with your surgeon the risks of not having an operation. The hernia may cause pain and increase in size. If the intestines become 'strangulated' or trapped in the hernia pouch it may cause sudden pain, vomiting, and an emergency operation will be required.
If you think you have inguinal hernia or just want to know more about your symptoms, you can start by speaking with your regular doctor.
If you do have inguinal hernia, you may need to speak with a specialist. These doctors are trained in diagnosing and treating inguinal hernia with all the available therapies.
