4. Treatment Options
There are various treatment options for inguinal hernias. Here are the principal ones.
If your hernia is small and causing no symptoms one option would be to watch and wait. However the natural history of these hernias is that they all do tend to increase in size over time and there is always an unpredictable risk of strangulation. The decision to operate will be made between you and your surgeon following discussion of the risks and benefits.
Surgery has been performed to repair groin hernias for nearly 150 years and many procedures have been described. Until about thirty years ago all operations involved suturing tissues together. This carries a high risk of both recurrence (hernias occur again at some point following this surgery) as well as high levels of chronic discomfort and pain. Consequently today the majority of surgeons employ the use of “plastic mesh”. There are many different meshes but they are all employed to repair the defect in the anterior abdominal wall. Over time scar tissue grows into this scaffolding and provides a long term strong repair. Mesh is employed in all modern surgical techniques and should allow much more rapid recovery following your operation than in the past. Whichever of the following operative techniques is used, 80% of patient will return home on the day of their surgery.
We offer the full range of surgical techniques and following consultation you will be offered the most appropriate procedure for you, including taking into account your preferred choice. Most patients are offered totally extra-peritoneal laparoscopic repair as we believe this provides the most rapid post operative recovery as well as the best outcome for you the patient. Collected data from our patients show currently median time to resumption normal activities and work 8 days (range 0-21).
Open Hernia Repair
This is the most widely employed technique in the United Kingdom. It requires an incision in the groin and the use of usually plastic mesh to repair the defect. This operation carries the advantages that it is simple to undertake, requires minimal technology and if necessary can be performed under local anaesthetic.
These minimally invasive procedures carry the advantage of rapid post operative recovery. Patients often experience minimal discomfort following surgery and can therefore resume normal activities rapidly. Multiple studies have compared laparoscopic and open techniques and almost all have confirmed more rapid convalescence and return to normal activities following laparoscopic procedures.
Laparoscopic operations carry the significant advantage that patients with hernias on both sides can be treated at the same time with minimal additional discomfort. Some patients present with recurrent hernias following failure of a previous operation. Laparoscopic repair is the procedure of choice in these patients as the risk of damaging nerves and blood vessels supplying the testicle are lower.
Laparoscopic surgery may not be for you if:
- Your hernia is very large
- Your hernia is incarcerated
- You have had previous pelvic surgery including prostatectomy
- You are unfit for general anaesthesia.
There are two kinds of laparoscopic operation:-
Totally Extra-peritoneal (TEP)
This is an advanced laparoscopic procedure. The surgery is performed through very small incisions whilst visualisation is accomplished with the use of a telescope and high resolution camera. Following reduction of the hernia prosthetic mesh is placed behind the defect to prevent recurrence. This procedure has the advantage that as the abdominal cavity is not actually entered and the surgery is undertaken between the peritoneum and abdominal wall muscles you should not experience shoulder tip pain, also injury to other organs within the abdomen is probably lower.
Trans-abdominal Pre-peritoneal (TAPP)
This is similar to TEP but the abdominal cavity is entered before the hernia is reduced. Consequently patients can experience shoulder pain because of gas within the abdominal cavity and there is a theoretical risk to internal abdominal organs.