Treatment of Inguinal Hernias

How is an Inguinal Hernia treated?


Laparoscopic surgery is performed using general anesthesia. The surgeon makes several small incisions in the lower abdomen and inserts a laparoscope—a thin tube with a tiny video camera attached to one end. The camera sends a magnified image from inside the body to a monitor, giving the surgeon a close-up view of the hernia and surrounding tissue. While viewing the monitor, the surgeon uses instruments to carefully repair the hernia using synthetic mesh.

People who undergo laparoscopic surgery generally experience a somewhat shorter recovery time. However, the doctor may determine laparoscopic surgery is not the best option if the hernia is very large or the person has had pelvic surgery.

Most adults experience discomfort after surgery and require pain medication. Vigorous activity and heavy lifting are restricted for several weeks. The doctor will discuss when a person may safely return to work. Infants and children also experience some discomfort but usually resume normal activities after several days.

“Open” hernia repair.

In open hernia repair, also called herniorrhaphy, a person is given local anesthesia in the abdomen or spine to numb the area, general anesthesia to sedate or help the person sleep, or a combination of the two. Then the surgeon makes an incision in the groin, moves the herniated tissues back into the abdomen, and reinforces the muscle wall with stitches. Usually the area of muscle weakness is reinforced with a synthetic mesh or screen to provide additional support—an operation called hernioplasty. Modern versions of this type of repair are called “plug and patch” and the “Lichtenstein” type repair. Recovery times are variable for patients depending on the amount of tissue being repaired. Typically several weeks of recovery are required and full activities are limited in the first four to six weeks to allow for the best results.

Conventional Tissue-to-Tissue Technique

To repair a hernia using the conventional tissue-to-tissue method, an incision is made over the hernia site and the hernia is returned to the abdomen. The surgeon repairs the hole by pulling the surrounding tissue and muscle over the defect. Several sutures are used to hold the muscle in place. No mesh is used in this repair. A classic version of this procedure is called the “Bassini” repair. This is method is “conventional” is it reflects how hernias were initially repaired. This repair is common in children because they are constantly growing and mesh would not grow with them. It is rare to see a adult inguinal hernia repaired this way today due to the higher recurrent hernia rates associated with failures of this type of repair. If there is some contraindication to mesh placement in a patient ( active infection) then this technique is used.

Operating time and typical recovery periods are longer than the other methods mentioned, and return to normal activities is approximately four to six weeks after surgery.

Dr. Gillian’s technique.

Over the course of a any year Dr Gillian may use nearly every technique available to repair particular  inguinal hernias but his preference in most cases is a a laparoscopic approach utilizing only three 5mm incisions and a lightweight mesh.  This is called a TAP technique and requires great skill  and experience but results in a rapid recovery, negligible visible scaring and a procedure that typically only takes about a 15-20 minute operative time. Some surgeons around the country who have less experience try to recreate this operation using a robot, bigger scars and much longer operative times.

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