There are many ways to treat a hernia and this suggests that non is superior in all aspects. I have experience in all methods described here and these treatments must be suited to the individual patient to give the greates chance of good surgical results.
Tailored Hernia Surgery
Every patient should be individualised to their surgical hernia repair. Depending on the patient’s wishes in addition to their age, occupation, general health, physical activities and the complexity of the hernia, the optimum surgical technique is chosen carefully between following methods.If unfit even for local anaesthesia a truss rarely may be an alternative to surgery. In this case minimally symptomatic direct inguinal herniae may be left with the risk of only 1-2% strangulation per year.
Anterior Repairs Via Groin
1. Minimal Repair / Herniotomy The technique is completely mesh free and is mainly designed for professional athletes with a sportsman’s hernia (pubalgia) or other patients with a small defects. Since the surrounding tissues are undamaged they are left intact. Due to this extremely sparing surgical technique the patient has less pain and can start strenuous physical exercise after 2 days.
2. Shouldice Repair The main feature of this technique is the reinforcing of each abdominal layer. This technique is predominantly used in contaminated or strangulated hernias as the need for mesh is avoided.
3. Lichtenstein Repair With the Lichtenstein technique, the defect is repaired with a mesh on top of the anterior muscle layers, this requires several sutures fixing the mesh in place. The Lichtenstein technique is often used in patients operated under only local anaesthetic.
4. Open TEP Repair This technique places a wide mesh underneath the abdominal facial between abdominal wall and peritoneum. This is the open version of the laparoscopic TEP, but avoids laparoscopic complications and can be carried out without general anaesthetic.
5. Laparoscopic Repair If suitable for general anaesthesia, recurrent and bilateral herniae are best repaired by laparoscopic inguinal hernia repair. From the 2 techniques TEP is generally agreed to be safer than TAP; avoiding the complications of visceral injury and later adhesions.
6. UHS Repair A recent technique using Light weight mesh that 60% absorbs, covering the defect anteriorly and posteriorly with few sutures to reduce chronic groin pain. This technique has been shown to give lowest recurrence rates with low rates of chronic groin pain as the mesh allows nerve ingrowth. Lightweight meshes such as these have been shown to cause a reduction in chronic pain.