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INGUINAL HERNIA TREATMENT OPTIONS

ABOUT
HERNIA
SURGERY

Hernia repair has been around for a long time. That means traditional techniques have been perfected while alternative options and materials have been developed. While not every technique is right for every hernia, they all have common goals: to provide the strongest repair and least chance of recurrence with minimal discomfort and quick recovery.

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Open Hernia Repair Incisions illustration

Traditional repair

Traditional open repair requires one or two 7cm - 15cm incisions.

OPEN 
TENSION
REPAIR

Laparoscopic Hernia Repair Incisions

Laparoscopic repair

Laparoscopic repair requires three or four 6mm - 13mm incisions.

OPEN
TENSION
REPAIR

About the recovery process

Here’s what you might expect as you recover, from the first day through the first few weeks.

What is an open tension repair

  • Open – an incision of 7cm -15cm is made in the abdomen to give the surgeon access to the hernia.
  • Tension – the edges of healthy tissue around the hernia are pulled together and sewn with sutures.
  • The incision is then closed with dissolving sutures or abdominal adhesive.

This method has been used historically and may be the only way to repair a very large hernia. The incision could potentially cause pain and recovery can take as long as five to six weeks. The incision also leaves a scar, although it’s usually very low on the abdomen.

NON-TENSION
OR MESH
REPAIR

About the recovery process

Here’s what you might expect as you recover, from the first day through the first few weeks.

WHAT IS NON-TENSION OR MESH REPAIR

Non-tension 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 even self-gripping mesh that requires few to no sutures to keep it in place.

Surgeon looking

Laparoscopic 
repair

Many inguinal hernias can be repaired using a laparoscopic procedure. Laparoscopic repair entails inserting special instruments through small incisions in the abdomen through which the surgeon is able to visualise and perform the procedure. Laparoscopic repair uses mesh for reinforcement, so it has a lower recurrence rate.1-6

LAPAROSCOPIC PROCEDURE

  1. Your surgeon makes three or four 6mm - 13mm incisions in your abdomen. One is near your navel and the others lower down.
  2. A laparoscope, a fiber-optic tube with a tiny camera on the end, is inserted through one of the openings, allowing the surgeon to visualise the area on a monitor.
  3. The surgeon performs the procedure using surgical instruments inserted through the other openings while viewing it on the monitor. The mesh is positioned and fastened in place with sutures, tacks or self gripping mesh.
  4. The instruments are removed and the holes are closed with a stitch or glue and covered with surgical dressings.

Laparoscopic Hernia Repair Incisions
man smiling
Surgeon looking

Before the Surgery

A few days before surgery, the surgeon may order a pre-op exam consisting of blood tests, an EKG (electrocardiogram) and a chest X-ray to be sure the heart and lungs are in good condition. The surgeon will prescribe all necessary medications including natural or nutritional supplements. The surgeon may also give a prescription for pain medication to take after surgery.

THE DAY OF SURGERY

When arriving at the hospital for surgery, consent forms will need to be signed as part of the admission process. Blood pressure will be taken and you will be started on an IV (intravenous line). The area may need to be scrubbed and shaved to guard against infection. The anaesthetist will review the type of anaesthesia required. Medication may be given for relaxation before going to the operating room. In the operating room, the anaesthesia will be administered and the procedure will be completed.

ABOUT THE RECOVERY

LAPAROSCOPIC PROCEDURE

  1. Your surgeon makes three or four 6mm - 13mm incisions in your abdomen. One is near your navel and the others lower down.
  2. A laparoscope, a fiber-optic tube with a tiny camera on the end, is inserted through one of the openings, allowing the surgeon to visualise the area on a monitor.
  3. The surgeon performs the procedure using surgical instruments inserted through the other openings while viewing it on the monitor. The mesh is positioned and fastened in place with sutures, tacks or self gripping mesh.
  4. The instruments are removed and the holes are closed with a stitch or glue and covered with surgical dressings .

Hernia hero image 8

FACTS & TIPS

  • Find a surgeon who specialises in hernia surgery and has experience with the latest techniques, to make sure you have the most options.
  • Make sure the surgeon explains which procedure is recommended and why.
  • Make sure to tell your surgeon about all medications and supplements you take: prescription, over the counter and natural.

REFERENCES

1

Pavlidis TE, Atmatzidis KS, Lazaridis CN, et al. Comparison between modern mesh and conventional non-mesh methods of inguinal hernia repair. Minerva Chir. 2002;57(1):7–12.

2

Shi Y, Su Z, Li L, et al. Comparing the effects of Bassini versus tension-free hernioplasty: 3 years’ follow up. Front Med China. 2010;4(4):463–468.

3

Elsebae MM, Nasr M, Said M. Tension-free repair versus Bassini technique for strangulated inguinal hernia: A controlled randomized study. Int J Surg. 2008;6(4):302–305.

4

Aytac B, Cakar KS, Karamercan A. Comparison of Shouldice and Lichtenstein repair for treatment of primary inguinal hernia. Acta Chir Belq. 2004;104(4):418–421.

5

Malik AM, Khan A, Jawaid A, et al. A comparative analysis between non-mesh (Bassini’s) and mesh (Lichtenstein) repair of primary inguinal hernia. J Ayub Med Coll Abbottabad. 2009;21(1):17–20.

6

Butters M, Redecke J, Koninger J. Long-term results of a randomized clinical trial of Shouldice, Lichtenstein and transabdominal preperitoneal hernia repairs. Br J Surg. 2007;94(5):562–565.