Hernia Repair

About Hernia Repair

Hernia repair is one of the most frequently performed operations in general surgery. A hernia is a protrusion of tissue, often fat or bowel, through a weak area of the abdominal wall. Inguinal hernias in the groin are the most common type and occur far more often in men; other types include femoral, umbilical and incisional hernias. Modern inguinal repair is usually tension free and uses a synthetic mesh to reinforce the weakened area. In the open Lichtenstein technique, popularized by the American surgeon Irving Lichtenstein in the 1980s, a mesh is placed through a groin incision over the posterior wall of the inguinal canal. Earlier tissue repairs such as the Bassini and Shouldice operations sew the tissues together without mesh. Laparoscopic repair places a mesh in the preperitoneal space behind the abdominal wall, covering the myopectineal orifice. The transabdominal preperitoneal approach, TAPP, enters the abdominal cavity and raises a peritoneal flap, while the totally extraperitoneal approach, TEP, stays outside the peritoneum and has a steeper learning curve. Laparoscopic repair is associated with less early pain and allows hernias on both sides to be repaired through the same small incisions, but usually requires general anesthesia. Mesh may be fixed with tacks, sutures or glue. Recurrence after mesh repair is uncommon. Chronic groin pain is a recognized complication, and nerve sparing technique aims to reduce it. For people with minimal symptoms, careful observation is an accepted alternative, while strangulation of a hernia is a surgical emergency.