A hernia is a weakness or “hole” in the muscles of the abdominal wall. It will not disappear on its own and if it is not treated there is a risk of “strangulation” of the contents of the hernia.
Nowadays, most hernias are repaired by using a mesh – often made of polypropylene (“Prolene”) to strengthen the muscles. This can be by conventional “open” surgery or by laparoscopic “keyhole” methods.
A consultation will help to determine which of these might be suitable for you, and to discuss the benefits and risks of each.
Open repair of inguinal (groin) hernias
The most common way of repairing groin hernias, often called inguinal hernias is the Lichtenstein method. This can be done under a local or a general anaesthetic. A cut around 3 inches long is made over the hernia. The hernia is put back inside and the muscles are strengthened by stitching in place a piece of mesh. Almost everyone who undergoes groin hernia surgery goes home the same day, regardless of the type of repair.
There has been a lot of discussion in recent years both in the media and in medical circles about the use of mesh in surgery. Largely, this was about mesh used in gynaecology operations for prolapse. There is little evidence to suggest that hernia mesh in itself causes pain, although of course the surgery itself can be responsible for pain. There is however, no doubt that using mesh to repair hernias gives much better long term results in terms of remaining free from another hernia appearing in the same place. I am very happy to discuss this issue with you at consultation if you have any remaining concerns. Personally, I would want mesh to be used if I had a hernia operation.
Laparoscopic (keyhole) repair of inguinal hernias
Three small holes are made in the lower abdomen and instruments are used to bring the hernia back inside, then place a mesh behind the muscles. This needs to be done under a general anaesthetic. The laparoscopic method of inguinal hernia repair has been shown in large studies to be less painful in the short and long term by comparison with the open method, and the recovery time is therefore shorter.
The National Institute for Clinical Excellence (NICE) has said that ‘laparoscopic surgery for inguinal hernia should only be performed by specially trained surgeons who regularly carry out the procedure.
There are many other types of hernia including femoral, incisional, umbilical, epigastric and Spigelian. They can all be repaired by either open or laparoscopic methods. Whatever type of hernia you have, my intention is to discuss the main options and to advise you on what I feel is the most appropriate method.