Your Hernia Surgery

About Your 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 the minimal discomfort and quick recovery.

Open Tension Repair

Here is what an open tension repair means:

  • 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. Tension repair has a higher recurrence rate than non-tension, or mesh, repair.

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.

Laparoscopic or Closed Repair

Many inguinal hernias can be repaired using a laparoscopic procedure. Laparoscopic repair entails inserting special instruments through tiny 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 tiny 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 .

Before Your Surgery

A few days before surgery, your surgeon may order a pre-op exam consisting of blood tests, an EKG (electrocardiogram), and a chest X-ray to be sure your heart and lungs are in good condition. You may be instructed to stop taking some over-the-counter medications for a week to 10 days before surgery, such as aspirin or ibuprofen which can increase bleeding. Make sure your surgeon knows all the prescription and over-the-counter medications you take, including natural or nutritional supplements. You may also be given a prescription for pain medication to take after surgery, in case you need it. Fill the prescription before your surgery in case you need the medication after.

The Day of Surgery

  1. When you arrive at the hospital the morning of your surgery; you will sign consent forms, change into a hospital cap and gown, have your blood pressure taken, and be started on an IV (intravenous line). The area of your hernia may need to be scrubbed and shaved to guard against infection.
  2. The anaesthetist will meet with you and review the type of anaesthesia you and your surgeon have decided on. You’ll be given medication to relax you.
  3. Next you’ll be taken to the operating room, your anaesthesia will be administered and then you will have your procedure completed.

References

1

Pavlidis TE, Atmatzidis KS, Lazaridis CN, Papaziogas BT, Makris JG, Papaziogas TB. 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, Liu H, Jing C. 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, Laghari AA, Talpur KA. 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.

7

Vrijland WW, van den Tol MP, Luijendijk RW, et al. Randomized clinical trial of non-mesh versus mesh repair of primary inguinal hernia. Br J Surg. 2002;89(3):293–297.