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 Hernia Surgery Clinik

Center for Advanced Hernia Repairs and General Surgery

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What is inguinal hernia?

Causes?

Treatment

Policy

Open repair with mesh

Open repair without mesh

Laparoscopic repair

 

 

Inguinal / Groin Hernia

Inguinal hernia

Inguinal Hernia is by far the most common type of hernia we see in society. It is the highest number of hernia cases operated worldwide. Inguinal hernia occurs at the inguinal fold which is very close to groin.

Inguinal hernia occurs more in males than females. Females have this hernia very rarely. Mostly men suffer from this type of Hernia.

This is also called as groin hernia.

List of causes of Inguinal hernia:

All these factors weakens the natural orifices/holes in the groin region. due to increased abdominal pressure the intestines and other organs are pushed through these weak holes.When such thing happens the tone of muscles around these holes gives way and these contents start protruding outside this defective hole. Once they come out of this defect they start to adhere to the wall of the sac. Sac is nothing but the peritoneal cover of the intestines.

Females: Inguinal hernia in females occurs on the same principles but the contents contain the ligaments of the uterus. So along with the intestines they have the ligaments of uterus which are already present there.

Treatment:

Treatment for the inguinal hernia is always a surgery.

There is tremendous importance of timely performed Inguinal hernia surgery in terms of success and avoiding recurrence .

Policy: Hernia Surgery |

Policy which is adopted for inguinal hernia surgery is the "Early the surgery less is the chance of recurrence in future."

Surgery for Inguinal hernia:

There are 3 types of inguinal hernia surgeries that are performed.

  1. Open repair of inguinal hernia with a mesh placement ( Recommended by us )
  2. Open repair of inguinal hernia with anatomical repair without mesh implant.
  3. Laparoscopic repair of inguinal hernia with placement of mesh ( TEP / TAPP )

Open repair of inguinal hernia with a mesh placement ( Recommended by us )

Here in this open repair , we do take a very small incision ( cut ) about 1-1.5 inches. Through this small cut we open the inguinal hernia and retrieve the sac of hernia. we push back the contents of the hernia back into the abdomen . After this the sac of hernia is tied at the base and cut off. The remaining portion of the sac is transfixed and transposed below the internal inguinal ring ( defect ) in a way that will prevent the downward direction of the contents of the hernia. In future this will be a big hurdle for the hernia to overcome . so the chances of recurrence is reduced by 50 %.This is a very crucial and important step of hernia surgery. After this first repair we reinforce the wall of inguinal canal , that is the backbone of inguinal canal in any person. This is a second repair what we do for the hernia. In this repair the loose muscles and wall are stitched together so that they become strong enough to hold the contents. The process of strengthening in inguinal canal adds to the strenght of repair.

This second repair will reduce the chance of recurrence by 30 % in future. So this way extra loose , flabby muscles are reduced to one strong , capable structure. The third repair which comes into picture is after repairing all the probable defects in inguinal canal. This is the placement of mesh at the defect. This is a very advanced polypropylene material which have large size pores/holes which will give a very strong repair and support to the tissues in the inguinal canal. We put many devices like mesh, PHS,UHS systems int o this defect according to the need of the patient.

After the placement of the mesh the defect is completely closed without leaving any possibility to be invaded by any visceral organ. This completes the repair and wound / cut is closed by sutures/staples/liquid sealents.

Anesthesia  used:

Here we use following type of anesthesia according to need and recommendation:

Benefits:

  1. Complete repair of defect
  2. No area remain untouched
  3. Triple repair
  4. almost no recurrence ( less than 2 % )
  5. quick recovery
  6. painless
  7. No restrictions on activity

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Open repair of inguinal hernia with anatomical repair without mesh implant.

This is another very useful surgery in terms of prevention of recurrence in inguinal hernia.

First few steps of this surgery are same as above mentioned surgery. But when it comes to placement of the mesh , anatomical repair is done.

anantomical repair is used to give strength to the posterior wall of inguinal canal. Mesh is not used in this variant of surgery. Here we use a small strip of the cover of the fascia instead of the mesh.This strip serves the function of the mesh. This anatomical repair is done using the strip of tissue from patients body itself , so in terms of repair this is quickly accepted by the body. There is no foreign body reaction. This reduces chances of recurrence considerably.

Only the issue that needs to be faced sometimes while doing surgery is the strenght of the tissue strip itself. In some diseases like diabetes or muscle weakness this tissue strip becomes very thin and friable so that it can seldom be used for giving strength. ( only disadvantage of this type of surgery )

Benefits:

  1. Complete repair of defect
  2. No area remain untouched
  3. Triple repair
  4. almost no recurrence ( less than 2 % )
  5. quick recovery
  6. painless
  7. No restrictions on activity
  8. No foreign body
  9. mesh not used.

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Laparoscopic repair of inguinal hernia with palcement of mesh ( TEP / TAPP )

These repairs are the Extraperitoneal Laparoscopic Repair (TEP) and the Trans-Abdominal Preperitoneal Repair (TAPP).

Currently, the two most popular laparoscopic techniques are the TAPP and the TEP.  

The most ardent critique of the TAPP procedure is that it is an intra-abdominal procedure with significant potential morbidity. On the other hand, the TEP procedure  avoids intra-abdominal access. In our studies, the morbidity rate of both these laparoscopic repairs was minimal and/or similar to other open repairs with comparable early recurrence rates. The most persuasive argument for using this procedure is the same argument favoring all laparoscopic procedures: the postoperative benefits to the patients, i.e., less postoperative pain, decreased disability and small incisions. However, it continues to be a procedure with limited long term follow-up and analysis. We strongly believe surgeons performing laparoscopic inguinal hernia repair should be familiar with the TEP and TAPP Repair.

Most randomized studies comparing laparoscopy to open repair have confirmed the following findings: 

Laparoscopic inguinal herniorrhaphy can refer to any of the following 3 techniques:

TAPP REPAIR

·         We use these  techniques in the following settings:

·         - Incarcerated Inguinal-Femoral Hernia: TAPP Repair,

·         - Inguino-Femoral Hernia / Patients with previous major lower abdominal surgery: TEP Repair,

·         - Massive Inguinal Hernias with scrotal extension: TEP Repair or Anterior Repair,

·         - Bilateral Inguinal Hernias: TAPP or TEP Repair.

Contraindications

 

 

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