Inguinal hernia repair

Inguinal hernias are by far the most common hernia seen.  They appear in about 30% of men and about 3% of women.  

Hernias occur in the groin because of a developmental weakness that remains from early childhood.  When we are very small a passageway exists to allow the testicle to descend from within the abdomen into the scrotum.  This passageway closes off but is always weaker than the remainder of the abdominal wall. in later life ths passageway can reopen and allow the contents of the abdomen to protrude through the groin.  This is an inguinal hernia.

The hernia will usually contain a small amount of fat but may also contain a part of the bowel.  Often the hernia can be painful when it appears the pain reducing over time.  Whilst it is small the hernia may not cause too much trouble but as it gets larger it can become more painful.

Incarceration and strangulation

Usually a hernia will appear when you stand up and disappear when you lie down, as the contents move in and out of the abdomen.  Sometimes if the hernia has been out for a long time it will become more painful and harder.   This happens becasue the contents of the hernia can swell.  If the contents swell too much it can be difficult for them to get back through the hernia defect into the abdomen.  If this occurs it is called incarceration.  Usually this can be resolved by lying down and relaxing the abdominal muscles this allows the hernia to slip back inside.  If the hernia does not reduce and becomes more painful you will need to come to a hospital urgently.  When the hernia becomes incarcerated the contents can swell so much that the blood supply is cut off.  This causes a great deal of pain and is called strangulation.  Strangulation of a hernia is a medical emergency and must be delt with in an Accident and Emergency unit.  

Incarceration and Strangulation are rare occuring in 4% of patients with hernia each year.  

Repair

Inguinal hernia repair is a very common operation with about 13 operations per 10,000 patients per year.  Most surgeons would expect to repair between 50 to 100 hernais per year.   A surgeon who specialises in hernia surgery may peform many more.  You should always ask how many hernias your surgeon has repiared and what their recurrence rate is.

The hernia is repiared by placing a mesh patch into the groin either between or inside the layers of muscle of the groin.

Once the mesh is in place it is very strong much stronger than the groin was before the repair  In view of this there should be no longterm restriction in activity following a hernia repair.   

Laparoscopic or Open?

There has been a lot of debate between surgeons about which repair is the best.  To some extent it depends which repair a surgeon is most comfortable with.  Specilised hernia surgeons will be experienced in both repairs and so will be happy to offer either.   The choice then depends on what is most important to you the patient.  Both methods produce very good results with a published failure rate for open repair of less than 5% and less than 10% for Laparoscopic repair.

This table might help 

Complication Open mesh repair TEPP Laparoscopic repair
Recurrence less than 5% More than 5%
Return to work 1 day longer 1 day shorter
Wound Pain More Less
Minor complication More Less
Major complication Much less Slightly more
For bilateral hernia Less effective More effective
For recurrent hernia Less effective More effective

 

The best thing to do is discuss what is important to you when you come for your consultation.

For more information on each operation click on the links below

Open tension free mesh repair

TEPP laparoscopic repair

 

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