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treatment options
Treatment
options for
hernia repair
Learn about the treatment options available for hernia repair - always discuss treatment options with a doctor.
About hernia surgery
Hernia repair has been around for a long time. Treatment options and techniques have improved over time 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.
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 and any nutritional supplements required. 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 the patient will be given a IV (intravenous line). The patient's surgical 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.
Facts and tips
- Find a surgeon who specialises in hernia surgery and has experience with the latest techniques, to make sure you have the information on all of the options available
- Make sure you understand the benefits and risks of your operation
- Make sure to tell your surgeon about all medications and supplements you take; prescription, over-the-counter, and natural
Download the discussion guide to help you prepare for an appointment with a doctor.
Understanding the risks
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:
- Return of the hernia
- Infection
- Injury to the bladder, blood vessels, intestines, or nerves
- Difficulty passing urine
- Continued pain
- Swelling of the testes or groin area
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.
Traditional open hernia repair
An incision is made through the abdominal wall near the site of the hernia defect (Figure 1). The hernia is repaired with mesh or by suturing (sewing) the muscle closed. The incision can range from 5cm to 10cm in length depending on the size and location of the hernia, and also the surgeon’s technique. The incision is one of the major causes of pain after surgery.
Laparoscopic hernia repair
This procedure is sometimes referred to as ‘keyhole surgery’. The hernia is repaired by mesh that is inserted through ports placed into small incisions in the abdomen, therefore eliminating the need for a large incision.
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 self-gripping mesh that requires few to no sutures to keep it in place.
A mesh-based repair technique is recommended for patients with symptomatic inguinal hernias.1,2
Traditional open repair
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 down on the abdomen.
In a traditional open hernia repair, the surgeon makes an incision near the hernia site and the hernia is reduced or pushed back into the abdomen. Most inguinal hernia repairs use mesh to close the muscle.3
Laparoscopic repair
Many inguinal hernias can be repaired using a laparoscopic procedure. Laparoscopic repair includes 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 and reinforcement. Provided that resources and expertise are available, laparo endoscopic techniques have faster recovery times, lower chronic pain risk and are cost effective.1
Laparoscopic procedures
1. The surgeon makes three or four 6mm-13mm incisions in the abdomen. One is near the navel and the others lower down.
2. A laparaoscope, a fibre optic tube with a tiny camera on the end, is inserted through one of the openings, allowing the surgeon to visualise the area on the 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.
References
- Simons MP, et al. (2018) International guidelines for groin hernia management. Hernia. https ://doi.org/10.1007/s1002 9-017-1668-x
- Simons MP, et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009 Aug;13(4):343-403. doi: 10.1007/s10029-009-0529-7. PMID: 19636493
- Gould J. Laparoscopic versus open inguinal hernia repair. Surg Clin North Am. 2008 Oct;88(5):1073-81, vii-viii. doi: 10.1016/j.suc.2008.05.008. PMID: 18790155